整合心肌灌注成像诊断通过¹³N-氨正电子发射断层扫描改善对功能性显著冠状动脉狭窄的检测。
Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by 13N-ammonia Positron Emission Tomography.
作者信息
Lee Joo Myung, Kim Chee Hae, Koo Bon-Kwon, Hwang Doyeon, Park Jonghanne, Zhang Jinlong, Tong Yaliang, Jeon Ki-Hyun, Bang Ji-In, Suh Minseok, Paeng Jin Chul, Cheon Gi Jeong, Na Sang-Hoon, Ahn Jung-Min, Park Seung-Jung, Kim Hyo-Soo
机构信息
From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul National University, Korea (B.-K.K., S.-H.N.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); and Department of Cardiology, Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (J.-M.A., S.-J.P.).
出版信息
Circ Cardiovasc Imaging. 2016 Sep;9(9). doi: 10.1161/CIRCIMAGING.116.004768.
BACKGROUND
Recent evidence suggests that the diagnostic accuracy of myocardial perfusion imaging is improved by quantifying stress myocardial blood flow (MBF) in absolute terms. We evaluated a comprehensive quantitative (13)N-ammonia positron emission tomography ((13)NH3-PET) diagnostic panel, including stress MBF, coronary flow reserve (CFR), and relative flow reserve (RFR) in conjunction with relative perfusion defect (PD) assessments to better detect functionally significant coronary artery stenosis.
METHODS AND RESULTS
A total of 130 patients (307 vessels) with coronary artery disease underwent both (13)NH3-PET and invasive coronary angiography with fractional flow reserve (FFR) measurement. Diagnostic accuracy, optimal cut points, and discrimination indices of respective (13)NH3-PET quantitative measures were compared, with FFR as standard reference. The capacity to discern disease with stepwise addition of stress MBF, CFR, and RFR to qualitatively assessed relative PD was also gauged, using the category-free net reclassification index. All quantitative measures showed significant correlation with FFR (PET-derived CFR, r=0.388; stress MBF, r=0.496; and RFR, r=0.780; all P<0.001). Optimal respective cut points for FFR ≤0.8 and ≤0.75 were 1.99 and 1.84 mL/min per g for stress MBF and 2.12 and 2.00 for PET-derived CFR. Discrimination indices of quantitative measures that correlated with FFR ≤0.8 were all significantly higher than that of relative PD (area under the curve: 0.626, 0.730, 0.806, and 0.897 for relative PD, CFR, stress MBF, and RFR, respectively; overall comparison P<0.001). The capacity for functionally significant coronary stenosis was incrementally improved by the successive addition of CFR (net reclassification index=0.629), stress MBF (net reclassification index=0.950), and RFR (net reclassification index=1.253; all P<0.001) to relative PD.
CONCLUSIONS
Integrating quantitative (13)NH3-PET measures with qualitative myocardial perfusion assessment provides superior diagnostic accuracy and improves the capacity to detect functionally significant coronary artery stenosis.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01621438 and NCT01366404.
背景
最近的证据表明，通过绝对量化应激心肌血流量（MBF）可提高心肌灌注成像的诊断准确性。我们评估了一个综合定量（13）N-氨正电子发射断层扫描（（13）NH3-PET）诊断指标，包括应激MBF、冠状动脉血流储备（CFR）和相对血流储备（RFR），并结合相对灌注缺损（PD）评估，以更好地检测功能上有意义的冠状动脉狭窄。
方法与结果
共有130例冠状动脉疾病患者（307支血管）接受了（13）NH3-PET检查和有创冠状动脉造影及血流储备分数（FFR）测量。以FFR作为标准参考，比较了各（13）NH3-PET定量指标的诊断准确性、最佳切点和鉴别指数。还使用无类别净重新分类指数评估了在定性评估的相对PD基础上逐步增加应激MBF、CFR和RFR来识别疾病的能力。所有定量指标均与FFR显著相关（PET衍生的CFR，r = 0.388；应激MBF，r = 0.496；RFR，r = 0.780；均P < 0.001）。FFR≤0.8和≤0.75时，应激MBF的最佳切点分别为1.99和1.84 mL/min per g，PET衍生的CFR的最佳切点分别为2.12和2.00。与FFR≤0.8相关的定量指标的鉴别指数均显著高于相对PD的鉴别指数（曲线下面积：相对PD、CFR、应激MBF和RFR分别为0.626、0.730、0.806和0.897；总体比较P < 0.001）。通过在相对PD基础上依次增加CFR（净重新分类指数 = 0.629）、应激MBF（净重新分类指数 = 0.950）和RFR（净重新分类指数 = 1.253；均P < 0.001），功能上有意义的冠状动脉狭窄的检测能力逐步提高。
结论
将定量（13）NH3-PET指标与定性心肌灌注评估相结合可提供更高的诊断准确性，并提高检测功能上有意义的冠状动脉狭窄的能力。
临床试验注册
网址：http://www.clinicaltrials.gov。唯一标识符：NCT01621438和NCT01366404。
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