期刊
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
卷 15, 期 6, 页码 659-665出版社
OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jet274
关键词
Positron emission tomography; Coronary artery disease; Myocardial perfusion imaging; Myocardial blood flow; Myocardial perfusion reserve
资金
- Finnish foundation for cardiovascular research, Helsinki, Finland
- The Academy of Finland Centre of Excellence in Molecular Imaging in Cardiovascular and Metabolic Research, Helsinki, Finland
- Turku University Hospital
- The Turku Collegium for Science and Medicine of University of Turku, Turku, Finland
Objectives We compared the accuracy of quantified myocardial flow reserve and absolute stress myocardial blood flow (MBF) alone in the detection of coronary artery disease (CAD). Background Myocardial flow reserve, i.e. ratio of stress and rest flow, has been commonly used to detect CAD with many imaging modalities. However, it is not known whether absolute stress flow alone is sufficient for detection of significant CAD. Methods We enrolled 104 patients with moderate (30-70%) pre-test likelihood of CAD without previous myocardial infarction. MBF was measured by positron emission tomography and O-15-water at rest and during the adenosine stress in the regions of the left anterior descending, left circumflex, and right coronary artery. All the patients underwent invasive coronary angiography including the measurement of fractional flow reserve when appropriate. Results Quantified myocardial flow reserve (optimal cut-off value 2.5) detected significant coronary stenosis with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 81, 87, 66 and 94%, respectively. When compared with flow reserve, absolute MBF at stress (optimal cut-off value of 2.4 mL/min/g) was more accurate in detecting significant coronary stenosis [area under the curve (AUC) 0.94 vs. 0.90, P = 0.02] with sensitivity, specificity, PPV, and NPV of 95% (P = 0.03 vs. flow reserve), 90, 73, and 98%, respectively. An absolute increase of MBF from rest to stress by < 1.5 mL/g/min had also similar accuracy in detecting CAD(AUC: 0.95). The results were comparable in patients who did and did not receive i.v. beta-blockers prior imaging. Conclusions Absolute stress perfusion alone was superior to perfusion reserve in the detection of haemodynamically significant CAD and allows shorter imaging protocols with smaller radiation dose.
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