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Repeatable and reproducible measurements of myocardial oxidative metabolism, blood flow and external efficiency using 11C-acetate PET

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Non-invasive approaches to investigate myocardial efficiency can help track the progression of heart failure (HF). This study evaluates the repeatability and reproducibility of 11C-acetate positron emission tomography (PET) imaging of oxidative metabolism.

Methods and results

Dynamic 11C-acetate PET scans were performed at baseline and followup (47 ± 22 days apart) in 20 patients with stable HF with reduced ejection fraction. Two observers blinded to patients’ clinical data used FlowQuant® to evaluate test–retest repeatability, as well as intra- and inter-observer reproducibility of 11C-acetate tracer uptake and clearance rates, for the measurement of myocardial oxygen consumption (MVO2), myocardial external efficiency (MEE), work metabolic index (WMI), and myocardial blood flow. Reproducibility and repeatability were evaluated using intra-class-correlation (ICC) and Bland–Altman coefficient-of-repeatability (CR). Test–retest correlations and repeatability were better for MEE and WMI compared to MVO2. All intra- and inter-observer correlations were excellent (ICC = 0.95-0.99) and the reproducibility values (CR = 3%-6%) were significantly lower than the test–retest repeatability values (22%-54%, P < 0.001). Repeatability was improved for all parameters using a newer PET–computed tomography (CT) scanner compared to older PET-only instrumentation.

Conclusion

11C-acetate PET measurements of WMI and MEE exhibited excellent test–retest repeatability and operator reproducibility. Newer PET–CT scanners may be preferred for longitudinal tracking of cardiac efficiency.

Spanish Abstract

Antecedentes

el abordaje no invasivo para investigar la eficiencia miocárdica puede ayudar en el seguimiento de la progresión de la insuficiencia cardíaca. Este estudio evalúa la repetibilidad y la reproducibilidad del estudio de metabolismo oxidativo con PET 11C-acetato.

Métodos y resultados

Se realizaron estudios de PET 11C-acetato dinámicos al inicio y durante el seguimiento (47 ± 22 días de diferencia) en 20 pacientes con insuficiencia cardíaca estable y fracción de eyección reducida. Dos observadores cegados a los datos clínicos de los pacientes utilizaron FlowQuant® para evaluar la repetibilidad de la prueba-reprueba, así como la reproducibilidad intra e interobservador de la captación de radiotrazador 11C-acetato y sus tasas de eliminación, la medición del consumo miocárdico de oxígeno (MVO2), la eficiencia externa miocardica (EEM), el índice trabajo-metabólico (ITM) y flujo sanguíneo miocárdico (FSM). La reproducibilidad y la repetibilidad se evaluaron mediante la correlación intraclase (ICC) y el coeficiente de repetibilidad (CR) de Bland-Altman. Las correlaciones Prueba-Reprueba y la repetibilidad fueron mejores para la EEM y el ITM en comparación con el MVO2. Todas las correlaciones intra e interobservador fueron excelentes (ICC = 0.95-0.99) y los valores de reproducibilidad (CR = 3-6%) fueron significativamente menores que los valores de repetibilidad prueba-reprueba (22-54%, p <0.001). La repetibilidad fue mejor para todos los parámetros utilizando un equipo PET-TC más nuevo en comparación con un equipo PET sin CT.

Conclusión

las mediciones del PET con 11C-acetato del ITM y EEM mostraron una excelente repetibilidad prueba-preprueba y reproducibilidad del operador. Los nuevos equipos PET-CT pueden ser elegidos para el seguimiento longitudinal de la eficiencia miocárdica.

Chinese Abstract

背景

采用非侵入式方法来研究心肌代谢效率可以帮助追踪心力衰竭的过程。本研究评估利用碳-11 醋酸盐为 PET 显影剂行氧化代谢成像的可重复性和可再现性。

方法和结果

纳入射血分数减低的 20 名稳定性心衰患者,对患者基线和 47±22 天随访都进行碳-11 醋酸盐 PET 扫描。为测量心肌耗氧量(MVO2), 心肌外效率(MEE), 工作代谢指标(WMI)和心肌血流量(MBF), 两名观察者按照双盲的方法利用 FlowQuant®对碳-11 醋酸盐的摄取率和清空率进行了重复性测试以及不同观察者之间的可再现性测试。采用组内相关系数(ICC)和 Bland Altman 可重复性系数(CR)分别对可再现性和可重复性进行评估。MEE 和 WMI 的两次试验系数和可重复性优于MVO2。所有观察者之间的相关系数都较好(ICC=0.95-0.99),可再现性系数的值(CR=3-6%)明显低于两次试验可重复性的值(22-54%, P<0.001)。相比于旧的只有 PET 的设备, 采用新型 PET-CT 扫描仪能够使所有参数的可再现性都有所提高。

结论

碳-11醋酸盐 PET 显像测量 WMI 和 MEE 有很好的可重复性和可再现性。新的 PET-CT 扫描仪可能更适合于心脏代谢效率的长期追踪。

French Abstract

Contexte

Les examens non invasifs de la fonction myocardique aident à suivre la progression de l’insuffisance cardiaque. Dans ce travail, nous avons évalué la répétabilité et la reproductibilité de l’étude du métabolisme oxydatif du myocarde par imagerie tomographique à positrons avec l’acétate marqué au carbone 11.

Méthodes et résultats

Une étude de base et un second examen TEP dynamique à l’ acétate marqué au carbone 11 ont été réalisés (47 ± 22 jours) chez 20 patients présentant une insuffisance cardiaque stable avec une fraction d’éjection réduite. Sans aucune connaissance des données cliniques et au moyen du programme FlowQuant®, deux observateurs ont évalué la répétabilité des TEPs de base et de leur suivi, la reproductibilité intra- et inter-observateur, l’absorption et la clearance du traceur, la mesure de la consommation d’oxygène du myocarde (MVO2), l’efficacité contractile du myocarde (MEE), l’index métabolique du travail myocardique (WMI) et le débit sanguin myocardique (MBF). La reproductibilité et la répétabilité ont été évaluées en utilisant la corrélation intra-classe (ICC) et le coefficient de répétabilité Altman (CR). Les corrélations entre les études de base et leur suivi et la répétabilité des données se sont avérées supérieures pour les paramètres MEE et WMI par rapport à MVO2. Toutes les corrélations intra- et inter-observateurs furent excellentes (ICC = 0,95-0,99). Les valeurs de reproductibilité (CR = 3-6%) furent significativement inférieures aux valeurs de répétabilité (22-54%, p <0.001). La répétabilité des paramètres mesurés s’est avérée supérieure avec un scanner TEP-TDM de nouvelle génération par rapport à l’utilisation de la TEP sans TDM

Conclusion

Les mesures réalisées dans cette étude TEP 11C-acétate montre une excellent répétabilité et reproductibilité des paramètres WMI et WMI entre les examens de base et leur suivi effectués par des opérateurs différents. Les nouveaux scanners TEP-TDM devraient être préférés pour le suivi longitudinal de la fonction cardiaque.

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Abbreviations

LVEF:

Left ventricular ejection fraction (%)

OSA:

Obstructive sleep apnea

LVOT:

Left ventricle outflow tract

MVO2 :

Myocardial oxygen consumption (mL O2·min−1·g−1 tissue)

WMI:

Work metabolic index (mmHg·mL−1·m−2)

MEE:

Myocardial external efficiency (unitless fraction)

MBF:

Myocardial blood flow (mL blood·min−1·g−1 tissue)

ICC:

Intra-class correlation coefficient

ANOVA:

Analysis of variance

SD:

Standard deviation

CR:

Coefficient-of-repeatability (1.96 × SD)

IQR:

Inter-quartile range

NPC:

Non-parametric coefficient-of-repeatability (1.45 × IQR)

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Author notes

  1. JNC thanks Erick Alexanderson MD, Carlos Guitar MD, and Diego Vences MD, UNAM, Mexico, for providing the Spanish abstract; Haipeng Tang MS, Zhixin Jiang MD, and Weihua Zhou PhD, for providing the Chinese abstract; and Jean-Luc Urbain, MD, PhD, CPE, Past President CANM, Chief Nuclear Medicine, Lebanon VAMC, PA, for providing the French abstract.

Authors and Affiliations

  1. Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON, K1Y4W7, Canada

    Kai Yi Wu BHSc, Vincent Dinculescu MD, Jennifer M. Renaud MASc, Shin-Yee Chen MD, Ian G. Burwash MD, Lisa M. Mielniczuk MD, Rob S. B. Beanlands MD & Robert A. deKemp PhD

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  1. Kai Yi Wu BHSc
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  2. Vincent Dinculescu MD
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  3. Jennifer M. Renaud MASc
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  4. Shin-Yee Chen MD
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  5. Ian G. Burwash MD
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  6. Lisa M. Mielniczuk MD
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  7. Rob S. B. Beanlands MD
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  8. Robert A. deKemp PhD
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Corresponding author

Correspondence to Robert A. deKemp PhD.

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Disclosures

JM Renaud (JMR) and R deKemp (RdK) receive royalties from FlowQuant® sales. JMR, RdK and RS Beanlands (RSB) are consultants for Jubilant DraxImage (JDI). RdK receives royalties from rubidium PET technology licenses. RSB is a consultant for Lantheus Medical Imaging (LMI), receives research grants from LMI and JDI; he is a Heart and Stroke Foundation of Ontario (HSFO) Career Investigator, Vered Chair of Cardiology and uOttawa Tier-1 Chair in Cardiovascular Imaging Research. L Mielniczuk is a HSFO mid-career clinician-scientist and uOttawa Tier-2 Chair in Heart Failure Research. The other authors (KY Wu, V Dinculescu, SY Chen and IG Burwash) have no conflict of interest with regards to the work. This study was funded by HSFO (T-6426, NA-7158) and Canadian Institutes of Health Research (CIF-99470) Grants.

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Wu, K.Y., Dinculescu, V., Renaud, J.M. et al. Repeatable and reproducible measurements of myocardial oxidative metabolism, blood flow and external efficiency using 11C-acetate PET. J. Nucl. Cardiol. 25, 1912–1925 (2018). https://doi.org/10.1007/s12350-018-1206-y

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  • DOI: https://doi.org/10.1007/s12350-018-1206-y

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