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Absolute Resting 13N-Ammonia PET Myocardial Blood Flow for Predicting Myocardial Viability and Recovery of Ventricular Function after Coronary Artery Bypass Grafting

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

We aimed to evaluate the feasibility of resting myocardial blood flow (rMBF), quantified with dynamic 13 N-Ammonia (NH3) PET, for identifying myocardial viability and predicting improvement of left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG).

Methods

Ninety-three patients with coronary artery disease (CAD) and chronic LVEF < 45%, scheduled for CABG, had dynamic 13NH3 PET and 18F-FDG PET imaging. The perfusion/metabolism polar maps were categorized in four patterns: normal (N), mismatch (M1), match (M2) and reverse mismatch (RM). The value of rMBF for identifying viable myocardium (M1, RM) and post CABG improvement of LVEF≥8% was analyzed by receiver operating characteristic (ROC) curves. Correlations of rMBF in segments to ΔLVEF post CABG were verified.

Results

Mean rMBFs were significantly different (N=0.60±0.14; M1=0.44±0.07, M2=0.34±0.08, RM=0.53±0.09 ml/min/g, P<0.001). The optimal rMBF cutoff to identify viable myocardium was 0.42 ml/min/g (sensitivity=88.3%, specificity=82.0%) and 0.43 ml/min/g for predicting improvement of LVEF ≥8% (74.6%, 80.0%). The extent and rMBF of combined M1/RM demonstrated a moderate to high correlation to improved LVEF (r=0.78, 0.71, P<0.001).

Conclusion

Resting MBF, derived by dynamic 13NH3 PET, may be positioned as a supplement to 18F-FDG PET imaging for assessing the presence of viable myocardium and predicting potential improvement of LVEF after CABG.

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Abbreviations

AC:

Accuracy

AUC:

Area under curve

CABG:

Coronary artery bypass grafting

CT:

Computed X-ray tomography

18F-FDG:

18Fluor-2-fluoro-2-deoxyglucose

LVEF:

Left ventricular ejection fraction

MBF:

Myocardial blood flow

13NH3 :

13Nitrogen-Ammonia

NPV:

Negative predictive value

PET:

Positron emission tomography

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

RPC:

Reproducibility coefficient

SRS:

Summed rest score

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Acknowledgements

This research was supported by the research grant from Key Project of Tianjin Health and Family Planning Commission, Tianjin City, China (Grant Number: 16KG145), and Health and Technology Project of Tianjin Binhai New Health Bureau, Tianjin City, China (Grant Number: 2015BWKL002). This article was finalized under the auspices of the ‘‘Mentorship at Distance’’ committee of the Journal of Nuclear Cardiology. We gratefully acknowledge the editorial suggestions by Professor Frans J. Th. Wackers, MD, PhD.

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All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Teda International Cardiovascular Hospital Nuclear Medicine Department, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, 300457, China

    Jiao Wang, Jian-ming Li & Shuai Li

  2. Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA

    Bailing Hsu

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  1. Jiao Wang
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Wang, J., Li, Jm., Li, S. et al. Absolute Resting 13N-Ammonia PET Myocardial Blood Flow for Predicting Myocardial Viability and Recovery of Ventricular Function after Coronary Artery Bypass Grafting. J. Nucl. Cardiol. 29, 987–999 (2022). https://doi.org/10.1007/s12350-020-02388-7

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