Quantitative blood flow evaluation of vasodilation-stress compared with dobutamine-stress in patients with end-stage liver disease using 82Rb PET/CT
Our aim was to determine if end-stage liver disease (ESLD) is associated with an attenuated response to vasodilator-stress or dobutamine-stress using 82Rb-PET MPI with blood flow quantification.
Methods and Results
Pre-liver transplant patients who had a normal dipyridamole-stress (n = 27) or dobutamine-stress (n = 26) 82Rb PET/CT MPI study with no identifiable coronary artery calcium were identified retrospectively and compared to a prospectively identified low-risk of liver disease dipyridamole-stress control group (n = 20). The dipyridamole-stress liver disease group had a lower myocardial flow reserve (MFR) (1.89 ± 0.79) than the control group (2.79 ± 0.96, P < .05). The dobutamine-stress group had a higher MFR than both other groups (3.69 ± 1.49, P < .05). A moderate negative correlation between MELD score and MFR was demonstrated for the dipyridamole-stress liver disease group (r = − 0.473, P < .05). This correlation was not observed for the dobutamine-stress liver disease group (r = − 0.253, P = .21). The liver failure group as a whole (n = 53) had a higher resting myocardial blood flow (0.97 ± 0.33 mL/min/g) than the control group (0.82 ± 0.26, P < .05).
Dipyridamole demonstrates an attenuated vasodilatory response in ESLD patients compared to a non-ESLD control group related to higher resting blood flow and comparatively reduced stress blood flow. Dobutamine does not demonstrate this effect implying it may be the preferred pharmacologic MPI stress agent for ESLD patients.
KeywordsPET myocardial blood flow MPI vasodilators dobutamine CAD
The authors would like to thank Aarondeep Shokar for his data collection contribution to this work.
Robert A deKemp receives royalties from Jubilant DraxImage for the sale of Ruby-Fill generators, is a consultant to Jubilant DraxImage, and receives revenue shares from the sale of FlowQuant. Ran Klein receives royalties from Jubilant DraxImage for the sale of Ruby-Fill generators, is a consultant to Jubilant DraxImage, and receives revenue shares from the sale of FlowQuant. Jonathan T. Abele, Monique Raubenheimer, Vincent G. Bain, Greg Wandzilak, Naji AlHulaimi, Richard Coulden, Randall G Williams, Robert S Warshawski and Lucille D Lalonde have nothing to declare.
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