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Feasibility and diagnostic accuracy of exercise treadmill nitrogen-13 ammonia PET myocardial perfusion imaging of obese patients

Abstract

Background

Treadmill exercise nitrogen-13 (13N)-ammonia positron emission tomography (PET) has logistical challenges and limited literature. We aimed to assess its feasibility, image quality, and diagnostic accuracy in obese and nonobese patients.

Methods and Results

Between 2009 and 2012, 10,804 patients were referred for myocardial perfusion imaging, including 300 for treadmill PET, of whom 265 were included in this study. Treadmill testing and PET were performed using standard procedures. Image quality, perfusion, and summed stress score (SSS) were assessed. Invasive coronary angiography was performed within 90 days of PET in 43 patients. Mean ± SD body mass index (BMI) was 35.7 ± 7.7 kg/m2 (range 19.5-63.5 kg/m2). Feasibility of treadmill 13N-ammonia PET was 100%. Exercise duration was less for obese patients than nonobese patients (P < .001). Image quality was rated good for 96.9% of obese and 100% of nonobese patients. For all patients, sensitivity was 86.4% and specificity was 74.4%. Diagnostic accuracy did not change significantly with increasing BMI. SSS remained significant in predicting angiographic coronary artery disease after adjustment for age, sex, and Duke treadmill score.

Conclusions

Treadmill 13N-ammonia PET is highly feasible, yields good image quality, and has moderately high diagnostic accuracy in a small subset of obese and nonobese patients who are deemed able to perform treadmill exercise.

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Acknowledgments

We thank the Clinical Translational Sciences Activities Center at Mayo Clinic for statistical support of this project. This publication was supported by grant number UL1 TR000135 from the National Center for Advancing Translational Sciences. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We also thank the nurses, nuclear technologists, and members of the cyclotron facility at Mayo Clinic who contributed immensely to the success of this project. Dr Drozdova’s work on the project was supported by European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123) International Clinical Research Center of St. Anne’s University Hospital in Brno).

Disclosures

Dr Chareonthaitawee receives a research grant from Astellas Pharma Inc. The other authors have nothing to disclose.

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Correspondence to Panithaya Chareonthaitawee MD.

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See related editorial, doi:10.1007/s12350-015-0099-2.

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Aggarwal, N.R., Drozdova, A., Wells Askew, J. et al. Feasibility and diagnostic accuracy of exercise treadmill nitrogen-13 ammonia PET myocardial perfusion imaging of obese patients. J. Nucl. Cardiol. 22, 1273–1280 (2015). https://doi.org/10.1007/s12350-015-0073-z

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Keywords

  • Coronary artery disease
  • exercise stress testing
  • myocardial perfusion imaging
  • obesity
  • positron emission tomography