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Review
. 2023 Jul;25(7):351-357.
doi: 10.1007/s11883-023-01107-0. Epub 2023 May 10.

The Role of Cardiac PET in Diagnosis and Prognosis of Ischemic Heart Disease: Optimal Modality Across Different Patient Populations

Malek Nayfeh  1 , Ahmed Ibrahim Ahmed  1 , Jean Michel Saad  1 , Fares Alahdab  1 , Mouaz Al-Mallah  2
Affiliations
Review

The Role of Cardiac PET in Diagnosis and Prognosis of Ischemic Heart Disease: Optimal Modality Across Different Patient Populations

Malek Nayfeh et al. Curr Atheroscler Rep. 2023 Jul.

Abstract

Purpose of review: Despite single-photon emission computerized tomography (SPECT) being the most used nuclear imaging technique for diagnosis of coronary artery disease (CAD), many now consider positron emission tomography (PET) as a superior modality. This review will focus on the advances of cardiac PET in recent years and its advantages compared to SPECT in diagnosis and prognosis of CAD.

Recent findings: PET's higher resolution and enhanced diagnostic accuracy, as well as lower radiation exposure, all help explain the rationale for its wider spread and use. PET also allows for measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR), which aids in several different clinical scenarios, such as diagnosing multivessel disease or identifying non-responders. PET has also been shown to be useful in diagnosing CAD in various specific populations, such as patients with prior COVID-19 infection, cardiac transplant, and other comorbidities.

Keywords: Ischemia; Myocardial flow reserve; Myocardial perfusion; Positron emission tomography.

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Conflict of interest statement

Dr. Mouaz Al-Mallah receives research support from Siemens unrelated to this study. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
A 53-year-old male with hypertension and dyslipidemia presented with chest pain with exertion. PET relative perfusion imaging showed no defect. a The ejection fraction was 45% at rest and increased to 51% at stress. However, the total coronary artery calcium scoring was 3558, with calcifications noted in the LAD, LCx, and RCA. The global myocardial flow reserve was borderline (2.1), primarily because of reduced stress flow (1.14 ml/g/min). b Balanced ischemia was suspected, and the patient was referred for Invasive angiography, which showed multivessel disease with obstructive stenosis in the distal LM, proximal-to-mid LAD, proximal-to-mid LCx, and mid-RCA (red arrows). The patient subsequently underwent triple vessel CABG (LIMA to LAD, SVG to PDA, and SVG to OM). c On a recent follow-up visit 1.5 years from CABG, the patient continued his guideline-directed therapy, experienced no incident cardiovascular events, and reported no symptoms
See this image and copyright information in PMC

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