title: Diagnostic value of PET-measured heterogeneity in myocardial blood flows during cold pressor testing for the identification of coronary vasomotor dysfunction.
abstract: BACKGROUND
  We aimed to evaluate the diagnostic value of a positron emission tomography (PET)-measured heterogeneity in longitudinal myocardial blood flow (MBF) during cold pressor testing (CPT) and global MBF response to CPT from rest (DeltaMBF) for identification of coronary vasomotor dysfunction.
  
  
  RESULTS
  In 35 patients CPT-induced alterations in epicardial luminal area were determined with quantitative angiography as the reference. MBF was assessed over the whole left ventricle as global MBF and regionally in the mid and mid-distal myocardium as MBF difference or MBF heterogeneity with nitrogen-13 ammonia and PET. The sensitivity and specificity of a longitudinal MBF difference during CPT in the identification of epicardial vasomotor dysfunction were significantly higher than the global DeltaMBF to CPT (88% vs 79% and 82% vs 64%, respectively; P < .05). Combining both parameters resulted in an optimal sensitivity of 100% at the expense of an intermediate specificity of 73%. The diagnostic accuracy was higher for the combined analysis than that for the MBF difference alone and global DeltaMBF alone (91% vs 86% and 74%, respectively; P < .05).
  
  
  CONCLUSIONS
  The combined evaluation of a CPT-induced heterogeneity in longitudinal MBF and the change in global MBF from rest may emerge as a new promising analytic approach to further optimize the identification and characterization of coronary vasomotor dysfunction.
authors.affiliation: Department of Nuclear Cardiology, Cardiovascular Center, University Hospital of Geneva, Geneva, Switzerland. thomas.schindler@hcuge.ch <thomas.schindler@hcuge.ch>
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Schindler
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Zhang
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vincenti
authors.forename: Leila
authors.initials: L
authors.lastname: Mhiri
authors.forename: Rene
authors.initials: R
authors.lastname: Nkoulou
authors.forename: Hanjoerg
authors.initials: H
authors.lastname: Just
authors.forename: Osman
authors.initials: O
authors.lastname: Ratib
authors.forename: Francois
authors.initials: F
authors.lastname: Mach
authors.forename: Magnus
authors.initials: M
authors.lastname: Dahlbom
authors.forename: Heinrich R
authors.initials: HR
authors.lastname: Schelbert
mesh_terms: D003080:Cold Temperature; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014666:Vasomotor System / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology