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Role of quantitative myocardial blood flow and 13N-ammonia washout for viability assessment in ischemic cardiomyopathy

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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

Positron emission tomography (PET) integrating assessment of perfusion with 13N-ammonia (NH3) and viability with 18F-fluorodeoxyglucose (FDG) has high accuracy to identify viable, hibernating myocardium. We tested whether quantification of myocardial blood flow (MBF) and washout (k2) can predict myocardial viability using FDG as standard of reference.

Methods

In 180 consecutive patients with ischemic cardiomyopathy, myocardium was categorized on a segment-level into normal, ischemic, hibernating, and scar. From dynamic images, stress MBF, rest MBF, and k2 were derived and myocardial flow reserve (MFR) and volume of distribution (VD) were calculated.

Results

Across myocardial tissues, all parameters differed significantly. The area under the curve (AUC) was 0.564 (95% CI 0.527-0.601), 0.635 (0.599-0.671), 0.553 (0.516-0.591), 0.520 (0.482-0.559), and 0.560 (0.522-0.597) for stress MBF, rest MBF, MFR, k2, and VD. The generalized linear mixed model correctly classified 81% of scar as viable, hibernating myocardium. If the threshold of rest MBF to predict viability was set to 0.45 mL·min−1·g−1, sensitivity and specificity were 96% and 12%, respectively.

Conclusion

Quantitative NH3 PET parameters have low to moderate diagnostic performance to predict viability in ischemic cardiomyopathy. However, if rest MBF falls below 0.45 mL·min−1·g−1, viability testing by FDG-PET may be safely deferred.

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Abbreviations

PET:

Positron emission tomography

NH3:

13N-ammonia

FDG:

18F-fluorodeoxyglucose

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

VD:

Volume of distribution

LVEF:

Left ventricular ejection fraction

CAD:

Coronary artery disease

ROC:

Receiver-operating characteristics

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Acknowledgements

We thank Verena Weichselbaumer, Martina Vogt, Tania Lagrange, Kevin Frei, Kathrin Amsler, Frederic Koszarski und Bejtulah Salahi for their excellent technical support.

Disclosure

The University Hospital Zurich holds a research agreement with GE Healthcare. Dr. Dominik C. Benz reports a research Grant from the Theodor and Ida Herzog-Egli Foundation. Paola Ferro, Nico Safa, Michael Messerli, Elia von Felten, Wenjie Huang, Dimitri Patriki, Andreas A. Giannopoulos, Tobias A. Fuchs, Christoph Gräni, Catherine Gebhard, Aju P. Pazhenkottil, Philipp A. Kaufmann, and Ronny R. Buechel have nothing to disclose.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Dominik C. Benz MD, Paola Ferro MD, Nico Safa MD, Michael Messerli MD, Elia von Felten MD, Wenjie Huang MD, Dimitri Patriki MD, Andreas A. Giannopoulos MD, Tobias A. Fuchs MD, Christoph Gräni MD, Catherine Gebhard MD, Aju P. Pazhenkottil MD, Philipp A. Kaufmann MD & Ronny R. Buechel MD

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Benz, D.C., Ferro, P., Safa, N. et al. Role of quantitative myocardial blood flow and 13N-ammonia washout for viability assessment in ischemic cardiomyopathy. J. Nucl. Cardiol. 28, 263–273 (2021). https://doi.org/10.1007/s12350-019-01684-1

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