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Coronary flow reserve and relative flow reserve measured by N-13 ammonia PET for characterization of coronary artery disease

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Abstract

Objective

We evaluated the relationships between coronary flow reserve (CFR) and relative flow reserve (RFR) measured by N-13 ammonia positron emission tomography (PET) for characterization of epicardial coronary artery disease (CAD).

Methods

Sixty-nine consecutive stable angina patients underwent N-13 ammonia PET, coronary computed tomography angiography (CCTA), and if necessary, invasive coronary angiography (CAG) within 2 weeks. Myocardial blood flow (MBF), CFR, RFR, and coronary vascular resistance of the reference arterial territory (CVRref) were measured by N-13 ammonia PET. The presence of significant stenosis (SS) and diffuse atherosclerosis (DA) was evaluated on CCTA and CAG. Functional parameters measured by PET were compared among arteries with and without SS and DA.

Results

Arteries with SS and those with DA showed significantly lower stress MBF, as compared to those without. RFR was significantly lower in arteries with SS as compared to those without, while CFR was not. CFR was significantly lower in arteries with DA as compared to those without, while RFR was not. Among arteries without SS, CFR was significantly lower in those with DA as compared to those without. However, among arteries with SS, CFR was similar between those with and without DA. In contrast, RFR was significantly lower in arteries with SS, regardless of the presence of DA. CFR and RFR showed a weak positive correlation (r = 0.269) with discordance in 24 cases (35%). Among the arteries with CFR-RFR discordance, the prevalence of DA was significantly higher in those with low CFR but preserved RFR, as compared to those with preserved CFR but low RFR (75 vs 25%, p = 0.028). CVRref was significantly higher in arteries with DA, implicating a correlation of DA with underlying microvascular disease.

Conclusions

CFR and RFR measured by myocardial perfusion PET could provide a comprehensive information for characterization of epicardial CAD.

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Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A3B01006631).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea

    Sang-Geon Cho, Ki Seong Park, Jahae Kim & Ho-Chun Song

  2. Department of Cardiology, Chonnam National University Hospital, Gwang-ju, South Korea

    Ju Han Kim, Jae Yeong Cho & Young Joon Hong

  3. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea

    Sae-Ryung Kang, Zeenat Jabin, Hee Jeong Park, Geum-Cheol Jeong, Seong Young Kwon, Hyeon Sik Kim, Jung-Joon Min & Henry Hee-Seung Bom

  4. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea

    Jin Chul Paeng

  5. Nuclear Cardiology R&D Laboratory, Emory University, Atlanta, GA, USA

    Ernest V. Garcia

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  1. Sang-Geon Cho
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Correspondence to Henry Hee-Seung Bom.

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Cho, SG., Park, K.S., Kim, J. et al. Coronary flow reserve and relative flow reserve measured by N-13 ammonia PET for characterization of coronary artery disease. Ann Nucl Med 31, 144–152 (2017). https://doi.org/10.1007/s12149-016-1138-z

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  • DOI: https://doi.org/10.1007/s12149-016-1138-z

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