title: Coronary flow reserve and relative flow reserve measured by N-13 ammonia PET for characterization of coronary artery disease.
abstract: OBJECTIVE
  We evaluated the relationships between coronary flow reserve (CFR) and relative flow reserve (RFR) measured by N-13 ammonia positron emission tomography (PET) for characterization of epicardial coronary artery disease (CAD).
  
  
  METHODS
  Sixty-nine consecutive stable angina patients underwent N-13 ammonia PET, coronary computed tomography angiography (CCTA), and if necessary, invasive coronary angiography (CAG) within 2 weeks. Myocardial blood flow (MBF), CFR, RFR, and coronary vascular resistance of the reference arterial territory (CVRref) were measured by N-13 ammonia PET. The presence of significant stenosis (SS) and diffuse atherosclerosis (DA) was evaluated on CCTA and CAG. Functional parameters measured by PET were compared among arteries with and without SS and DA.
  
  
  RESULTS
  Arteries with SS and those with DA showed significantly lower stress MBF, as compared to those without. RFR was significantly lower in arteries with SS as compared to those without, while CFR was not. CFR was significantly lower in arteries with DA as compared to those without, while RFR was not. Among arteries without SS, CFR was significantly lower in those with DA as compared to those without. However, among arteries with SS, CFR was similar between those with and without DA. In contrast, RFR was significantly lower in arteries with SS, regardless of the presence of DA. CFR and RFR showed a weak positive correlation (r = 0.269) with discordance in 24 cases (35%). Among the arteries with CFR-RFR discordance, the prevalence of DA was significantly higher in those with low CFR but preserved RFR, as compared to those with preserved CFR but low RFR (75 vs 25%, p = 0.028). CVRrefwas significantly higher in arteries with DA, implicating a correlation of DA with underlying microvascular disease.
  
  
  CONCLUSIONS
  CFR and RFR measured by myocardial perfusion PET could provide a comprehensive information for characterization of epicardial CAD.
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Sang-Geon
authors.initials: SG
authors.lastname: Cho
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Ki Seong
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Jahae
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Sae-Ryung
authors.initials: SR
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Ho-Chun
authors.initials: HC
authors.lastname: Song
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, South Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Zeenat
authors.initials: Z
authors.lastname: Jabin
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Hee Jeong
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Geum-Cheol
authors.initials: GC
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Seong Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Hyeon Sik
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
authors.forename: Jung-Joon
authors.initials: JJ
authors.lastname: Min
authors.affiliation: Nuclear Cardiology R&D Laboratory, Emory University, Atlanta, GA, USA.
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea. hsbom@jnu.ac.kr.
authors.forename: Henry Hee-Seung
authors.initials: HH
authors.lastname: Bom
mesh_terms: D000641:Ammonia; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009590:Nitrogen Radioisotopes; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals
chemical_list: D009590:Nitrogen Radioisotopes; D019275:Radiopharmaceuticals; D000641:Ammonia
keywords: Coronary artery disease; Coronary flow reserve; Positron emission tomography; Relative flow reserve