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Sub-endocardial and sub-epicardial measurement of myocardial blood flow using 13NH3 PET in man

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

This study examined whether measuring myocardial blood flow (MBF) in the sub-endocardial (SEN) and sub-epicardial (SEP) layers of the left ventricular myocardium using 13NH3 positron emission tomography (PET) and an automated procedure gives reasonable results in patients with known or suspected coronary artery disease (CAD).

Methods

Resting and stress 13NH3 dynamic PET were performed in 70 patients. Using ≥ 70% diameter stenosis in invasive coronary angiography (ICA) to identify significant CAD, we examined the diagnostic value of SEN- and SEP-MBF, and coronary flow reserve (CFR) vs. the corresponding conventional data averaged on the whole wall thickness.

Results

ICA demonstrated 36 patients with significant CAD. Their global stress average [1.61 (1.26, 1.87) mL·min−1·g−1], SEN [1.39 (1.2, 1.59) mL·min−1·g−1] and SEP [1.22 (0.96, 1.44) mL·min−1·g−1] MBF were significantly lower than in the 34 no-CAD patients: 2.05 (1.76, 2.52), 1.72 (1.53, 1.89) and 1.46 (1.23, 1.89) mL·min−1·g−1, respectively, all P < .005. In the 60 CAD vs. the 150 non-CAD territories, stress average MBF was 1.52 (1.10, 1.83) vs. 2.06 (1.69, 2.48) mL·min−1·g−1, SEN-MBF 1.33 (1.02, 1.58) vs. 1.66 (1.35, 1.93) mL·min−1·g−1, and SEP-MBF 1.07 (0.80, 1.29) vs. 1.40 (1.12, 1.69) mL·min−1·g−1, respectively, all P < .05. Using receiver operating characteristics analysis for the presence of significant CAD, the areas under the curve (AUC) were all significant (P < .0001 vs. AUC = 0.5) and similar: stress average MBF = 0.79, SEN-MBF = 0.75, and SEP-MBF = 0.73. AUC was 0.77 for the average CFR, 0.75 for SEN, and 0.70 for SEP CFR. The stress transmural perfusion gradient (TPG) AUC (0.51) was not significant. However, stress TPG was significantly lower in segments subtended by totally occluded arteries vs. those subtended by sub-total stenoses: 1.10 (0.86, 1.33) vs. 1.24 (0.98, 1.56), respectively, P < .005.

Conclusion

Automatic assessment of SEN- and SEP-MBF (and CFR) using 13NH3 PET gives reasonable results that are in good agreement with the conventional average whole wall thickness data. Further studies are needed to examine the utility of layer measurements such as in patients with hibernating myocardium or microvascular disease.

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Abbreviations

CAD:

Coronary artery disease

CFR:

Coronary flow reserve

ICA:

Invasive coronary angiography

LV:

Left ventricle/ventricular

MBF:

Myocardial blood flow

PET:

Positron emission tomography

RV:

Right ventricle/ventricular

SEN:

Sub-endocardium/endocardial

SEP:

Sub-epicardium/epicardial

TPG:

Transmural perfusion gradient

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Disclosures

Tomasz Kubik, PhD, is Consultant at PMOD Technologies LLC, Zurich, Switzerland. All other authors have no conflict of interest and nothing to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Roberto Sciagrà MD, Rossella Di Dato MD, Michela Allocca MD & Raffaella Calabretta MD

  2. Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy

    Elisa Milan MD & Lara Gallo PhD

  3. Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Brescia, Italy

    Raffaele Giubbini MD & Luca Camoni MSc

  4. PMOD Technologies LLC, Zurich, Switzerland

    Tomasz Kubik PhD

  5. Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland

    Tomasz Kubik PhD

Authors
  1. Roberto Sciagrà MD
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  2. Elisa Milan MD
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  3. Raffaele Giubbini MD
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  4. Tomasz Kubik PhD
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  5. Rossella Di Dato MD
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  6. Lara Gallo PhD
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  8. Michela Allocca MD
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  9. Raffaella Calabretta MD
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Corresponding author

Correspondence to Roberto Sciagrà MD.

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Funding

This work was supported by the Italian Ministry of Health (RF 2010-2313451 and NET-2011-02347173).

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Sciagrà, R., Milan, E., Giubbini, R. et al. Sub-endocardial and sub-epicardial measurement of myocardial blood flow using 13NH3 PET in man. J. Nucl. Cardiol. 27, 1665–1674 (2020). https://doi.org/10.1007/s12350-018-1445-y

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  • DOI: https://doi.org/10.1007/s12350-018-1445-y

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