title: Patients with reduced heart rate response to adenosine infusion have low myocardial flow reserve in (13)N-ammonia PET studies.
abstract: To assess the effect of adenosine infusion by evaluating the relationship between heart rate (HR) response to adenosine and myocardial flow reserve (MFR) of remote regions supplied by normal coronary arteries in (13)N-ammonia PET. Thirty-one consecutive subjects (20 known coronary artery disease patients, 4 chronic heart failure patients, and 7 normal volunteers) except cases having 3-vessel disease underwent rest and adenosine stress (13)N-ammonia myocardial perfusion PET. Semi-quantitative, quantitative, and gated analyses were performed. Subjects were divided into two groups with regard to HR response to adenosine. Twenty-two subjects had normal HR response (peak/rest HR > 1.20), while reduced HR response (≤ 1.20) was observed in nine subjects. There were no differences in rest myocardial blood flow (MBF) of remote regions between the groups. Subjects with reduced HR response had significantly lower stress MBF and MFR of remote regions than those with normal HR response (stress MBF: 1.559 ± 0.517 vs. 2.279 ± 0.530, p = 0.004, MFR: 1.59 ± 0.36 vs. 2.35 ± 0.53, p = 0.001). There were no significant differences between the groups by means of semi-quantitative scoring. Rest and stress ejection fraction (EF) in the reduced HR response group was lower than that in the normal HR response group. In a multiple stepwise regression analysis, HR ratio, dyslipidemia, and Brinkman index were identified as predictors of the change in MFR of remote regions. Subjects with reduced HR response to adenosine had lower stress MBF and MFR of remote regions and lower EF. Moreover, HR response was one of the predictors of the change in MFR of remote regions.
authors.affiliation: Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan, tk2@nms.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomiyama
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Kumita
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishihara
authors.forename: Masaya
authors.initials: M
authors.lastname: Suda
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakurai
authors.forename: Kenta
authors.initials: K
authors.lastname: Hakozaki
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Takahashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Tomonari
authors.initials: T
authors.lastname: Kiriyama
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D000641:Ammonia; D016022:Case-Control Studies; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009590:Nitrogen Radioisotopes; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D009590:Nitrogen Radioisotopes; D019275:Radiopharmaceuticals; D000641:Ammonia; D000241:Adenosine
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