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Value of Vasodilator Left Ventricular Ejection Fraction Reserve in Evaluating the Magnitude of Myocardium at Risk and the Extent of Angiographic Coronary Artery Disease: A ⁸²Rb PET/CT Study

¹ Divisions of Nuclear Medicine and Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and ² Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

View larger version (10K): [in this window] [in a new window]   FIGURE 1.  Mean left ventricular end-diastolic volumes (A), end-systolic volumes (B) and ejection fraction (C) at rest and peak vasodilator stress in control patients and patients with normal and abnormal myocardial perfusion studies. *P < 0.001 compared with rest values.

View larger version (16K): [in this window] [in a new window]   FIGURE 2.  Scatter plot shows relation between magnitudes of stress-induced perfusion defects and LVEF reserve. SDS = summed difference score.

View larger version (13K): [in this window] [in a new window]   FIGURE 3.  Relation between magnitudes of stress-induced perfusion defects and LVEF reserve. Values represent mean ± SD. mod = moderate.

View larger version (17K): [in this window] [in a new window]   FIGURE 4.  Relation between angiographic extent of CAD and LVEF reserve. Values represent mean ± SD.

View larger version (22K): [in this window] [in a new window]   FIGURE 5.  (A and B) Agreement between extent of CAD determined by coronary angiography (x-axis) and myocardial perfusion defects alone (A) and by combined myocardial perfusion defects and abnormal LVEF reserve (B). No patients demonstrated defects in 3-vessel distribution. Disease extent was underestimated in half of patients with severe left main/3-vessel disease (no defects in 7% and defect in 1-vessel distribution in 43%). By combining perfusion and LVEF reserve, no patients were missed and most patients were correctly classified as having left main/3-vessel disease (86%).

View larger version (87K): [in this window] [in a new window]   FIGURE 6.  Relatively unremarkable rest-stress myocardial perfusion images with a significant decrease in LVEF during peak stress. Patient also had CT coronary angiogram immediately after PET study that demonstrated left dominant anatomy and severe calcified left main disease (bottom right; inset is cross section through left main artery) that was subsequently confirmed by catheter coronary angiography (bottom left). He underwent coronary artery bypass surgery. LVEDV = left ventricular end-diastolic volume; LVESV = left ventricular end-systolic volume; LM = left main coronary artery; RA = right atrium.

View larger version (71K): [in this window] [in a new window]   FIGURE 7.  Rest-stress myocardial perfusion PET/CT images in patient with severe angina demonstrate small region of moderate reversibility in middle and basal inferolateral walls. Gated study demonstrated significant decrease in LVEF during peak stress. Catheter coronary angiography demonstrated left dominant anatomy and severe left main CAD (bottom panel). Patient underwent coronary artery bypass surgery. LVEDV = left ventricular end-diastolic volume; LVESV = left ventricular end-systolic volume; LM = left main coronary artery.