Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15–labeled water PET

doi:10.1016/S1071-3581(02)43243-6

Journal of Nuclear Cardiology

Volume 10, Issue 3, May–June 2003, Pages 275-283

https://doi.org/10.1016/S1071-3581(02)43243-6 Get rights and content

Abstract

Background

Myocardial perfusion single photon emission computed tomography (SPECT) occasionally fails to detect coronary stenosis in patients with coronary artery disease (CAD). We evaluated coronary flow reserve (CFR) using oxygen 15–labeled water in areas with and without ischemia on technetium 99m tetrofosmin stress perfusion SPECT in patients with angiographically documented CAD.

Methods and results

Twenty-seven patients with CAD and eleven age-matched normal subjects were studied. Baseline myocardial blood flow (MBF) and MBF during hyperemia induced by intravenous adenosine triphosphate infusion (0.16 mg · kg⁻¹ · min⁻¹) were determined with the use of O-15–labeled water positron emission tomography, and the CFR was calculated. Tc-99m tetrofosmin stress/rest SPECT was performed for comparison. On the basis of the results of coronary angiography and SPECT, coronary segments were divided into 3 types: segments with coronary stenosis and a perfusion abnormality on stress SPECT imaging (group A, n = 16), segments with coronary stenosis without a perfusion abnormality (group B, n = 42), and remote segments with no coronary stenosis or perfusion abnormality (group C, n = 18). Baseline MBF values were similar among the 3 groups. CFR in group A was lower (1.82 ± 0.54) than in group B (2.22 ± 0.87, P < .05), in group C (2.92 ± 1.21, P < .01), and in normal segments (3.86 ± 1.24, P < .001). CFR in group B was lower than in group C (P < .02) and in normal segments (P < .001). CFR in group C was lower than in normal segments (P < .02).

Conclusions

Areas with a perfusion abnormality on stress SPECT had reduced CFR. In the areas without a perfusion abnormality and with coronary stenosis, lowering of CFR was intermediate between the areas with a perfusion abnormality and remote segments. Moreover, CFR was slightly, but significantly, lower in remote segments in patients with CAD compared with normal segments.

Section snippets

Study population

Twenty-seven consecutive patients with angiographically proven CAD were prospectively studied from August 2000 to August 2001 (22 men and 5 women aged 63.6 ± 8.9 years [mean ± SD]). Exclusion criteria included previous cardiac surgery, physiologically significant valvular heart disease, unstable angina, myocardial infarction, congestive heart failure, and chronic obstructive pulmonary disease. Remote segments of coronary vessels that previously had undergone any form of intervention were

Exercise stress test results

Eighteen patients underwent exercise treadmill exercise testing on perfusion SPECT. Of these, ten had angina or ECG changes during exercise. The peak heart rate achieved by these patients was 120.3 ± 22.7 beats/min. The peak RPP achieved by these patients was 21,540 ± 6,952 beats/min · mm Hg. The target heart rate was achieved by 4 patients (23.5%).

Hemodynamic data

In the PET study, baseline hemodynamic data in patients and normal volunteers were similar (Table 2). Heart rate and RPP were increased both in

Discussion

These data indicate that areas with perfusion abnormalities on stress/rest perfusion SPECT had reduced CFR. In the areas without a perfusion abnormality, CFR was also lower in those areas supplied by stenotic vessels than in remote or normal segments. Moreover, CFR in remote segments was slightly, but significantly, lower than in normal segments.

Acknowledgements

We express our gratitude to Hidetsugu Sakai, MD, and Kazushi Urasawa, MD, of the University of Hokkaido Cardiac Catheter Laboratories for their technical assistance.

The authors have indicated they have no financial conflicts of interest.

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Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15–labeled water PET

Abstract

Background

Methods and results

Conclusions

Section snippets

Study population

Exercise stress test results

Hemodynamic data

Discussion

Acknowledgements

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