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. 2021 Aug;28(4):1664-1672.
doi: 10.1007/s12350-019-01938-y. Epub 2019 Nov 8.

Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision

Shahnaz Akil  1   2 , Fredrik Hedeer  3 , Jenny Oddstig  4 , Thomas Olsson  4 , Jonas Jögi  3 , David Erlinge  5 , Marcus Carlsson  3 , Håkan Arheden  3 , Cecilia Hindorf  4 , Henrik Engblom  3
Affiliations

Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision

Shahnaz Akil et al. J Nucl Cardiol. 2021 Aug.

Abstract

Background: Many patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention.

Methods and results: Thirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest 13N-NH3 PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4 ± 3 weeks before and 5 ± 1 months after CA. The angiographer was blinded to the PET and CMR results. Myocardial flow reserve (MFR) < 2.0 by PET was considered abnormal. A PCI was performed in 19/33 patients. In 41% (11/27) of the revascularized vessel territories, a normal regional MFR was found prior to the PCI and no improvement in MFR was found at follow-up (P = 0.9). However, vessel territories with regional MFR < 2.0 at baseline improved significantly after PCI (P = 0.003). Of the 14 patients not undergoing PCI, four had MFR < 2.0 in one or more coronary territories.

Conclusion: Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.

Keywords: Coronary artery disease; coronary angiography; revascularization; stress imaging.

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Figures

Figure 1
Figure 1
An example of quantitative cardiac positron emission tomography (PET) findings in a patient undergoing revascularization in the RCA based on coronary angiography findings (white arrows). PET bull’s eye plots represent the distribution of the quantified absolute myocardial blood flows (mL·min−1·g−1 tissue) in the left ventricle. The color scales to the right of the bull’s eyes represent the flow ranges, with yellow red colors indicating higher flows and blue-green colors lower flows. In this case, the patient had a normal regional myocardial flow reserve (MFR) by cardiac PET in the RCA (MFR: 2.7)
Figure 2
Figure 2
Box and whisker’s plots of the (A) regional myocardial flow reserve (MFR) in 27 revascularized and 72 non-revascularized vessel territories, (B) global MFR, (C) global left ventricular ejection fraction (LVEF), and (D) peak oxygen uptake (VO2 peak) in patients before (baseline) and after (follow-up) revascularization
Figure 3
Figure 3
Effect of revascularization (follow-up) on myocardial flow reserve (MFR), as assessed by PET, in vessel territories with a baseline regional MFR (A) >2.0 (n = 11) and (B) <2.0 (n = 16). Note that a significant improvement in MFR for the vessel territories with decreased MFR prior to revascularization is not seen in vessel territories with normal MFR at baseline. The dashed line represents the cut-off value of regional MFR at 2.0
See this image and copyright information in PMC

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