John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA.
Eur J Nucl Med Mol Imaging. 2019 Jun;46(6):1226-1239. doi: 10.1007/s00259-019-04278-8. Epub 2019 Feb 26.
Revascularization aims to improve myocardial perfusion. However, changes in regional artery-specific quantitative perfusion after revascularization have not been systematically investigated. It is unclear whether artery-specific thresholds for coronary flow capacity (CFC) and/or relative perfusion predict improved stress perfusion after revascularization. We sought to determine the impact of revascularization based on predefined, artery-specific, severity size thresholds for CFC and/or relative perfusion defects.
Fifty patients underwent PET imaging before revascularization and then prospectively within 90 days after revascularization. Changes in regional myocardial blood flow (MBF) were stratified based on baseline perfusion abnormalities, baseline reduced CFC, and whether revascularization was performed in that region.
Following angiographic stenosis-directed revascularization, in regions with relative perfusion abnormalities and decreased CFC, stress MBF (sMBF) increased by 0.51 cm/min/g (59%) from baseline (p < 0.001). In regions without baseline perfusion abnormalities and yet decreased CFC, sMBF increased by 0.35 cm/min/g (40%) from baseline (p < 0.001). In regions without perfusion abnormalities and normal CFC, sMBF did not increase significantly (+0.07 cm/min/g, p = 0.56). Patients in whom revascularization was concordant with abnormal PET findings showed increased whole-heart sMBF (+0.22 cm/min/g, p < 0.001), but in patients in whom revascularization was targeted only to regions without perfusion abnormalities or low CFC, sMBF did not change significantly (-0.06 cm/min/g, p = 0.38).
Revascularization targeted to regions with reduced CFC and relative perfusion abnormalities on baseline PET yielded significant improvements in sMBF. When revascularization was performed in regions without reduced CFC, sMBF did not improve.
血运重建旨在改善心肌灌注。然而，血运重建后区域性动脉特异性定量灌注的变化尚未得到系统研究。尚不清楚冠状动脉血流储备（CFC）和/或相对灌注的动脉特异性阈值是否能预测血运重建后应激灌注的改善。我们旨在确定基于 CFC 和/或相对灌注缺陷的预设、动脉特异性严重程度阈值的血运重建的影响。
50 例患者在血运重建前进行了 PET 成像，然后在血运重建后 90 天内进行前瞻性研究。根据基线灌注异常、基线 CFC 降低以及该区域是否进行血运重建，对区域性心肌血流（MBF）变化进行分层。
在有相对灌注异常和 CFC 降低的区域，在进行血管造影狭窄导向性血运重建后，应激 MBF（sMBF）比基线增加了 0.51cm/min/g（59%）（p<0.001）。在没有基线灌注异常但 CFC 降低的区域，sMBF 比基线增加了 0.35cm/min/g（40%）（p<0.001）。在没有灌注异常且 CFC 正常的区域，sMBF 没有显著增加（+0.07cm/min/g，p=0.56）。血运重建与异常 PET 结果一致的患者全心脏 sMBF 增加（+0.22cm/min/g，p<0.001），但仅针对无灌注异常或低 CFC 区域进行血运重建的患者 sMBF 没有显著变化（-0.06cm/min/g，p=0.38）。
针对基线 PET 显示 CFC 和相对灌注异常的区域进行血运重建可显著提高 sMBF。当在没有 CFC 降低的区域进行血运重建时，sMBF 没有改善。
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