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. 2022 Feb;29(1):293-303.
doi: 10.1007/s12350-020-02231-z. Epub 2020 Jun 21.

Papillary muscle ischemia on high-resolution cine imaging of nitrogen-13 ammonia positron emission tomography: Association with myocardial flow reserve and prognosis in coronary artery disease

Risako Nakao  1 , Michinobu Nagao  2 , Atsushi Yamamoto  1   3 , Kenji Fukushima  4 , Eri Watanabe  1 , Shuji Sakai  3 , Nobuhisa Hagiwara  1
Affiliations

Papillary muscle ischemia on high-resolution cine imaging of nitrogen-13 ammonia positron emission tomography: Association with myocardial flow reserve and prognosis in coronary artery disease

Risako Nakao et al. J Nucl Cardiol. 2022 Feb.

Abstract

Background: The evaluation of papillary muscle (PM) perfusion through existing perfusion imaging, including single-photon emission computed tomography and magnetic resonance imaging, is not possible. Therefore, this study sought to investigate the detection of PM ischemia in coronary artery disease (CAD) using nitrogen-13 (N-13) ammonia positron emission tomography (NH3 PET) and its association with global myocardial flow reserve (MFR) and major adverse cardiac events (MACE).

Methods: Data of adenosine-stress NH3 PET for 263 consecutive patients with known or suspected CAD were retrospectively analyzed. PM ischemia was defined as the absence of PM accumulation under stress conditions and PM presence at rest on high-resolution cine imaging derived from PET-computed tomography scanner with time-of-flight technology. The primary outcome was MACE.

Results: Of 263 patients, 30 experienced mean follow-up period of 910 days (MACE), while 31 (11.8%) presented PM ischemia. Compared to patients without PM ischemia, those with PM ischemia reported a significantly lower global MFR and a significantly higher rate of MACE (P < .0001).

Conclusion: NH3 PET enables the detection of PM ischemia in approximately 10% of patients with known or suspected CAD. PM ischemia is associated with reduced global MFR and is an important sign in predicting prognosis.

Keywords: Microvascular dysfunction; PET; diagnostic and prognostic application; myocardial blood flow; perfusion agents; vasodilators.

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