Teda International Cardiovascular Hospital Nuclear Medicine Department, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, 300457, China.
Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
J Nucl Cardiol. 2022 Jun;29(3):987-999. doi: 10.1007/s12350-020-02388-7. Epub 2020 Oct 21.
We aimed to evaluate the feasibility of resting myocardial blood flow (rMBF), quantified with dynamic 13 N-Ammonia (NH) PET, for identifying myocardial viability and predicting improvement of left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG).
Ninety-three patients with coronary artery disease (CAD) and chronic LVEF < 45%, scheduled for CABG, had dynamic NH PET and F-FDG PET imaging. The perfusion/metabolism polar maps were categorized in four patterns: normal (N), mismatch (M1), match (M2) and reverse mismatch (RM). The value of rMBF for identifying viable myocardium (M1, RM) and post CABG improvement of LVEF≥8% was analyzed by receiver operating characteristic (ROC) curves. Correlations of rMBF in segments to ΔLVEF post CABG were verified.
Mean rMBFs were significantly different (N=0.60±0.14; M1=0.44±0.07, M2=0.34±0.08, RM=0.53±0.09 ml/min/g, P<0.001). The optimal rMBF cutoff to identify viable myocardium was 0.42 ml/min/g (sensitivity=88.3%, specificity=82.0%) and 0.43 ml/min/g for predicting improvement of LVEF ≥8% (74.6%, 80.0%). The extent and rMBF of combined M1/RM demonstrated a moderate to high correlation to improved LVEF (r=0.78, 0.71, P<0.001).
Resting MBF, derived by dynamic NH PET, may be positioned as a supplement to F-FDG PET imaging for assessing the presence of viable myocardium and predicting potential improvement of LVEF after CABG.
本研究旨在评估通过动态 13N-氨（NH）PET 检测静息心肌血流（rMBF）来识别存活心肌和预测冠状动脉旁路移植术（CABG）后左心室射血分数（LVEF）改善的可行性。
93 例患有冠心病（CAD）和慢性 LVEF<45%的患者接受了动态 NH PET 和 F-FDG PET 成像。将灌注/代谢极地图分为四种模式：正常（N）、不匹配（M1）、匹配（M2）和反向不匹配（RM）。通过接收者操作特征（ROC）曲线分析 rMBF 对识别存活心肌（M1、RM）和 CABG 后 LVEF 提高≥8%的价值。验证了 rMBF 与 CABG 后ΔLVEF 之间的相关性。
平均 rMBF 差异显著（N=0.60±0.14；M1=0.44±0.07，M2=0.34±0.08，RM=0.53±0.09ml/min/g，P<0.001）。识别存活心肌的最佳 rMBF 截断值为 0.42ml/min/g（敏感性=88.3%，特异性=82.0%），预测 LVEF 提高≥8%的最佳 rMBF 截断值为 0.43ml/min/g（74.6%，80.0%）。M1/RM 联合的范围和 rMBF 与 LVEF 的改善呈中度至高度相关（r=0.78，0.71，P<0.001）。
通过动态 NH PET 获得的静息 MBF 可作为 F-FDG PET 成像的补充，用于评估存活心肌的存在并预测 CABG 后 LVEF 的潜在改善。
