title: Assessment of coronary flow reserve using a combination of planar first-pass angiography and myocardial SPECT: Comparison with myocardial (15)O-water PET.
abstract: Coronary flow reserve (CFR), defined as the ratio of maximum coronary flow increase from baseline resting blood flow, is one of the most sensitive parameters to detect early signs of coronary arteriosclerosis at the microvascular level. Myocardial perfusion PET is a well-established technology for CFR measurement, however, availability is still limited. The aim of this study is to introduce and validate myocardial flow reserve measurement by myocardial perfusion SPECT.
  
  
  METHODS
  Myocardial perfusion SPECT at rest and ATP stress (0.16mg/Kg/min) was performed in 10 patients with known coronary artery disease. Immediately after the injection of Tc-99m sestamibi (MIBI), left ventricular (LV) dynamic planar angiographic data were obtained for 90s. Coronary flow reserve index as measured by MIBI SPECT (CFRMIBI) was calculated as follows: CFRMIBI=CmsSbmb/CmbSbms, where subscripts b, s, Cm, and Sbm indicate baseline, during stress, myocardial counts with MIBI SPECT, and integral of LV counts with first pass angiography, respectively. Additionally, standard stress/rest (15)O-water PET to estimate CFR was performed in all patients as standard of reference.
  
  
  RESULTS
  CFRMIBI increased in conjunction with CFR, but underestimated blood flow at high flow rates. The relationship between CFRMIBI (Y) and CFRPET (X) was well fitted as follows: Y=1.40x(1-exp(1.79/x)) (r=0.84).
  
  
  CONCLUSIONS
  The index of CFRMIBI reflects the CFR by (15)O-water PET but underestimates flow at high flows, maybe as a reflection of pharmacokinetic limitations of MIBI.
authors: Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany.
authors: Naoko
authors: N
authors: Nose
authors: Division of Nuclear Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors: Kazuhito
authors: K
authors: Fukushima
authors: Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
authors: Constantin
authors: C
authors: Lapa
authors: Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany.
authors: Rudolf A
authors: RA
authors: Werner
authors: Department of Radiology, Johns Hopkins Medical Institution, MD, USA.
authors: Mehrbod Som
authors: MS
authors: Javadi
authors: Department of Nuclear Medicine, Kanazawa Graduate University of Medical Sciences, Ishikawa, Japan.
authors: Junichi
authors: J
authors: Taki
authors: Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; Division of Nuclear Medicine, Hyogo College of Medicine, Hyogo, Japan; Kanazawa Cardiovascular Hospital, Ishikawa, Japan. Electronic address: thiguchi@me.com.
authors: Takahiro
authors: T
authors: Higuchi
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000494:pharmacology; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi / Q000494:pharmacology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: Coronary flow reserve; MIBI; Myocardial perfusion; PET; SPECT