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Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to validate a new method to measure regional myocardial perfusion reserve (MPR) with technetium-labelled tracers in patients with type 2 diabetes mellitus (DM2).

Methods

A total of 40 consecutive DM2 patients without history of coronary artery disease (CAD) and 7 control subjects were recruited. Dipyridamole myocardial blood flow index (MBF) was assessed by measuring first transit counts in the pulmonary artery and myocardial count rate from gated SPECT images using 99mTc-labelled tracers. The corresponding MBF index was estimated 2 h later according to the same procedure. Regional myocardial perfusion reserve (MPR) was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular (LV) model. Coronary flow reserve (CFR) was estimated by transthoracic contrast echo Doppler monitoring of flow velocity in the left anterior descending coronary artery (LAD) during the same session.

Results

Estimated MPR was higher in control subjects than in patients (3.36 ± 0.66 vs 1.91 ± 0.61, respectively, p < 0.01). In patients, LAD CFR and LAD MPR were 2.01 ± 0.78 vs 1.93 ± 0.63, respectively (p = ns). The agreement between the two techniques was documented by their close correlation (r = 0.92, p < 0.001) and confirmed by the Bland-Altman analysis. Reversible perfusion defects occurred in 13 patients (32%) who showed similar MPR values as the remaining 27 (2.10 ± 0.71 vs 1.83 ± 0.71, respectively, p = ns). Finally, MPR was closely correlated with age (r = −0.50, p < 0.01) and time elapsed from the diagnosis of DM2 (r = −0.51, p < 0.01).

Conclusion

LV regional MPR can be accurately estimated with the broadly available single photon technology. Application of this method to DM2 patients documents the presence of a microvascular dysfunction homogeneously distributed throughout the LV walls and most frequently not associated with reversible perfusion defects.

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Acknowledgements

This study was supported in part by a Grant of Fondazione CARIGE for the year 2009 on “Diabetes and its vascular complications” and by the Grant Limonte of Regione Liguria.

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Authors and Affiliations

  1. CNR Institute of Bioimages and Molecular Physiology, Milan, Section of Genoa, Italy

    Cecilia Marini

  2. Department of Internal Medicine, Cardiology, University of Genoa, Genoa, Italy

    GianPaolo Bezante, Elisa Modonesi, Daniela Rollando, Manrico Balbi & Claudio Brunelli

  3. Department of Internal Medicine, Nuclear Medicine, University of Genoa, Genoa, Italy

    Patrizia Gandolfo, Silvia D. Morbelli, Riccardo Armonino & Gianmario Sambuceti

  4. Department of Endocrinological Metabolic Sciences, Diabetology, University of Genoa, Genoa, Italy

    Angelo DePascale, Davide Maggi, Manuela Albertelli & Renzo Cordera

  5. Advanced Biotechnology Center, Genoa, Italy

    Gianmario Sambuceti

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  1. Cecilia Marini
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Correspondence to Cecilia Marini.

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Marini, C., Bezante, G., Gandolfo, P. et al. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes. Eur J Nucl Med Mol Imaging 37, 357–367 (2010). https://doi.org/10.1007/s00259-009-1316-5

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  • DOI: https://doi.org/10.1007/s00259-009-1316-5

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