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Noninvasive Assessment of Coronary Collaterals in Man by PET Perfusion Imaging

Division of Cardiology, Positron Diagnostic and Research Center, The University of Texas Medical School, Houston, Texas
Division of Cardiology, University of California, Los Angeles, School of Medicine, Los Angeles, California

Correspondence: For reprints contact: Linda L. Demer, MD, PhD, Division of Cardiology, 47-123 CHS, UCLA School of Medicine, 10833 LeConte Ave., Los Angeles, CA 90024-1679.

ABSTRACT

At present, coronary collateralization cannot be identified or assessed noninvasively in patients. In animal studies, coronary collaterals are associated with coronary steal, defined as a regional fall in perfusion during coronary arteriolar vasodilation. To determine the effect of coronary arteriolar vasodilation on collateral bed perfusion in man, myocardial perfusion imaging was performed before and after pharmacologic coronary vasodilation in patients with coronary artery disease (CAD). Regional myocardial activity of ⁸²Rb or ¹³N ammonia was measured by positron emission tomography (PET) at rest and with intravenous dipyridamole/handgrip stress in 28 patients with angiographic collaterals and in 25 control patients with similar CAD severity by quantitative arteriography. Regional myocardial activity decreased after dipyridamole, indicating coronary steal, in 25 of 28 patients with angiographic collaterals and in only 4 of 25 control patients without angiographic collaterals. These findings suggest that developed collaterals are associated with myocardial steal in patients with CAD, allowing potential use of PET for noninvasive identification of coronary collateralization.

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