Stress myocardial blood flow correlates with ventricular function and synchrony better than myocardial perfusion reserve: A Nitrogen-13 ammonia PET study.
Cardiac PET quantifies stress myocardial blood flow (MBF) and perfusion reserve (MPR), while ECG-gated datasets can measure components of ventricular function simultaneously. Stress MBF seems to outperform MPR in the detection of significant CAD. However, it is uncertain which perfusion measurement is more related to ventricular function. We hypothesized that stress MBF correlates with ventricular function better than MPR in patients studied for suspected myocardial ischemia.



We studied 248 patients referred to a rest and adenosine-stress Nitrogen-13 ammonia PET. We performed a multivariate analysis using systolic function (left ventricular ejection fraction, LVEF), diastolic function (mean filling rate in diastole, MFR/3), and synchrony (Entropy) as the outcome variables, and stress MBF, MPR, and relevant covariates as the predictors. Secondarily, we repeated the analysis for the subgroup of patients with and without a previous myocardial infarction (MI).



166 male and 82 female patients (mean age 63 ± 11 and 67 ± 11 year, respectively) were included. 60% of the patients presented hypertension, 57% dyslipidemia, 21% type 2 diabetes mellitus, 45% smoking, and 34.7% a previous MI. Mean stress MBF was 1.99 ± 0.75 mL/g/min, MPR = 2.55 ± 0.89, LVEF = 61.6 ± 15%, MFR/3 = 1.12 ± 0.38 EDV/s, and Entropy = 45.6 ± 11.3%. There was a significant correlation between stress MBF (P < .001) and ventricular function. This was stronger than the one for MPR (P = .063). Sex, age, diabetes, and extent of previous MI were also significant predictors. Results were similar for the analyses of the 2 subgroups.



Stress MBF is better correlated with ventricular function than MPR, as evaluated by Nitrogen-13 ammonia PET, independently from other relevant cardiovascular risk factors and clinical covariates. This relationship between coronary vasodilatory capacity and ventricular function is sustained across groups with and without a previous MI.
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|PET/CT Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.|Department of Nuclear Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano #1 Col. Sección XVI Del. Tlalpan, C.P 14080, Mexico City, Mexico.
Luis Eduardo
LE
Juárez-Orozco
Department of Nuclear Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano #1 Col. Sección XVI Del. Tlalpan, C.P 14080, Mexico City, Mexico. erickalexandersonmd@gmail.com.|Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico. erickalexandersonmd@gmail.com.
Erick
E
Alexanderson
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Rudi A
RA
Dierckx
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Hendrikus H
HH
Boersma
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Johannes L
JL
Hillege
Department of Surgery (Division of Vascular Surgery), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Clark J
CJ
Zeebregts
PET/CT Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.|Department of Nuclear Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano #1 Col. Sección XVI Del. Tlalpan, C.P 14080, Mexico City, Mexico.
Myriam M
MM
Martínez-Aguilar
Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico.
Antonio
A
Jordán-Ríos
PET/CT Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
Ana Gabriela
AG
Ayala-German
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Niek
N
Prakken
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Rene A
RA
Tio
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands.
Riemer H
RH
Slart
D000368:Aged; D000641:Ammonia; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009590:Nitrogen Radioisotopes; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
D009590:Nitrogen Radioisotopes; C000615247:Nitrogen-13; D000641:Ammonia
PET; coronary artery disease; myocardial perfusion reserve; stress myocardial blood flow; ventricular function
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