Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland.
Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Eur Heart J Cardiovasc Imaging. 2024 Sep 30;25(10):1367-1373. doi: 10.1093/ehjci/jeae096.
This study aimed to assess the impact of adenosine on quantitative myocardial blood flow (MBF) in a rapid stress-rest protocol compared with a rest-stress protocol using 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) and to gain insights into the time dependency of such effects.
Quantitative MBF at rest (rMBF) and during adenosine-induced stress (sMBF) and myocardial flow reserve (MFR) were obtained from 331 retrospectively identified patients who underwent 13N-ammonia PET MPI for suspected chronic coronary syndrome and who all exhibited no perfusion defects. Of these, 146 (44.1%) underwent a rapid stress-rest protocol with a time interval (Δtstress-rest) of 20 ± 4 min between adenosine infusion offset and rest imaging, as per clinical routine. The remaining 185 (55.9%) patients underwent a rest-stress protocol and served as the reference. Groups did not differ regarding demographics, risk factors, medication, left ventricular function, and calcium scores. rMBF was significantly higher in the stress-rest vs. the rest-stress group [0.80 (interquartile range 0.66-1.00) vs. 0.70 (0.58-0.83) mL·min-1·g-1, P < 0.001], and, as sMBF was identical between groups [2.52 (2.20-2.96) vs. 2.50 (1.96-3.11), P = 0.347], MFR was significantly lower in the stress-rest group [3.07 (2.43-3.88) vs. 3.50 (2.63-4.10), P = 0.007]. There was a weak correlation between Δtstress-rest and rMBF (r = -0.259, P = 0.002) and between Δtstress-rest and MFR (r = 0.163, P = 0.049), and the proportion of patients with abnormally high rMBF was significantly decreasing with increasing Δtstress-rest.
Intravenously applied adenosine induces a long-lasting hyperaemic effect on the myocardium. Consequently, rapid stress-rest protocols could lead to an overestimation of rMBF and an underestimation of MFR.
本研究旨在使用 13N-氨正电子发射断层扫描（PET）心肌灌注成像（MPI）评估腺苷在快速应激-休息方案与休息-应激方案中对定量心肌血流（MBF）的影响，并深入了解这种效应的时间依赖性。
331 例回顾性识别的疑似慢性冠状动脉综合征患者接受了 13N-氨 PET MPI 检查，所有患者均未出现灌注缺陷。其中 146 例（44.1%）按照临床常规，在腺苷输注结束与休息成像之间间隔 20±4min 进行快速应激-休息方案。其余 185 例（55.9%）患者行休息-应激方案，作为参考。两组在人口统计学、危险因素、药物治疗、左心室功能和钙评分方面无差异。应激-休息组的 rMBF 明显高于休息-应激组[0.80（四分位距 0.66-1.00）比 0.70（0.58-0.83）mL·min-1·g-1，P＜0.001]，由于两组间 sMBF 相同[2.52（2.20-2.96）比 2.50（1.96-3.11），P=0.347]，因此 MFR 在应激-休息组明显较低[3.07（2.43-3.88）比 3.50（2.63-4.10），P=0.007]。Δtstress-rest 与 rMBF 之间存在弱相关性（r=-0.259，P=0.002），Δtstress-rest 与 MFR 之间存在弱相关性（r=0.163，P=0.049），并且随着 Δtstress-rest 的增加，rMBF 异常升高的患者比例明显下降。
静脉内应用腺苷会对心肌产生持久的充血效应。因此，快速应激-休息方案可能会导致 rMBF 高估和 MFR 低估。
