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Left ventricular function and volumes from gated [13N]-ammonia positron emission tomography myocardial perfusion imaging: A prospective head-to-head comparison against CMR using a hybrid PET/MR device

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Positron emission tomography (PET) myocardial perfusion imaging (MPI) can be used to evaluate left ventricular (LV) volumes and function. We performed a head-to-head comparison of LV function and volumes obtained simultaneously using [13N]-ammonia-PET and cardiac magnetic resonance (CMR), with the latter serving as the reference standard.

Methods and Results

In this prospective study, 51 patients underwent [13N]-ammonia-PET MPI and CMR using a hybrid PET/MR device. Left ventricular end-systolic volumes (LVESV), end-diastolic volumes (LVEDV), stroke volumes (LVSV), ejection fractions (LVEF), and segmental wall motion were analyzed for both methods and were compared using correlational and Bland-Altman (BA) analysis; segmental wall motion was compared using ANOVA. The agreement between [13N]-ammonia-PET and CMR for LVEF was good, with minimal bias (− .6%) and narrow BA limits of agreement (− 7.9% to 6.8%), but [13N]-ammonia-PET systematically underestimated LV volumes, with high bias in LVESV (− 11.2 ml), LVEDV (− 28.9 ml), and LVSV (− 17.5 ml). Mean segmental wall motion in [13N]-ammonia-PET differed significantly among the corresponding normokinetic (6.6 ± 2 mm), hypokinetic (5.1 ± 2 mm), and akinetic (3.3 ± 2 mm) segments in CMR (P < .01).

Conclusion

LVEF and LV wall motion can be accurately assessed using [13N]-ammonia-PET MPI, although LV volumes are significantly underestimated compared to CMR.

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Abbreviations

CMR:

Cardiac magnet resonance tomography

LV:

Left ventricle

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

LVSV:

Left ventricular stroke volume

MBq:

Megabecquerel

MR:

Magnetic resonance

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

References

  1. Triposkiadis F, Butler J, Abboud FM, Armstrong PW, Adamopoulos S, Atherton JJ. The continuous heart failure spectrum: Moving beyond an ejection fraction classification. Eur Heart J 2019;40:2155‐63.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nkoulou R, Fuchs TA, Pazhenkottil AP, Kuest SM, Ghadri JR, Stehli J, et al. Absolute myocardial blood flow and flow reserve assessed by gated SPECT with cadmium-zinc-telluride detectors using 99mTc-tetrofosmin: Head-to-head comparison with 13N-ammonia PET. J Nucl Med 2016;57:1887‐92.

    Article  CAS  PubMed  Google Scholar 

  3. Klein R, Celiker-Guler E, Rotstein BH, deKemp RA. PET and SPECT tracers for myocardial perfusion imaging. Semin Nucl Med 2020;50:208‐18.

    Article  PubMed  Google Scholar 

  4. Giubbini R, Bertoli M, Durmo R, Bonacina M, Peli A, Faggiano I, et al. Comparison between N(13)NH3-PET and (99m)Tc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J Nucl Cardiol 2021;28:1906‐18.

    Article  PubMed  Google Scholar 

  5. Hickey KT, Sciacca RR, Bokhari S, Rodriguez O, Chou RL, Faber TL, et al. Assessment of cardiac wall motion and ejection fraction with gated PET using N-13 ammonia. Clin Nucl Med 2004;29:243‐8.

    Article  PubMed  Google Scholar 

  6. Peelukhana SV, Banerjee R, Kolli KK, Fernandez-Ulloa M, Arif I, Effat M, et al. Benefit of ECG-gated rest and stress N-13 cardiac PET imaging for quantification of LVEF in ischemic patients. Nucl Med Commun 2015;36:986‐98.

    Article  PubMed  Google Scholar 

  7. Khorsand A, Graf S, Eidherr H, Wadsak W, Kletter K, Sochor H, et al. Gated cardiac 13N-NH3 PET for assessment of left ventricular volumes, mass, and ejection fraction: Comparison with electrocardiography-gated 18F-FDG PET. J Nucl Med 2005;46:2009‐13.

    CAS  PubMed  Google Scholar 

  8. Kanayama S, Matsunari I, Kajinami K. Comparison of gated N-13 ammonia PET and gated Tc-99m sestamibi SPECT for quantitative analysis of global and regional left ventricular function. J Nucl Cardiol 2007;14:680‐7.

    Article  PubMed  Google Scholar 

  9. Kiko T, Yoshihisa A, Yokokawa T, Misaka T, Yamada S, Kaneshiro T, et al. Direct comparisons of left ventricular volume and function by simultaneous cardiac magnetic resonance imaging and gated 13N-ammonia positron emission tomography. Nucl Med Commun 2020;41:383‐8.

    Article  PubMed  Google Scholar 

  10. Bakula A, Patriki D, von Felten E, Benetos G, Sustar A, Benz DC, et al. Splenic switch-off as a novel marker for adenosine response in nitrogen-13 ammonia PET myocardial perfusion imaging: Cross-validation against CMR using a hybrid PET/MR device. J Nucl Cardiol 2020. https://doi.org/10.1093/ehjci/ehaa946.0289.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lassen ML, Rasul S, Beitzke D, Stelzmuller ME, Cal-Gonzalez J, Hacker M, et al. Assessment of attenuation correction for myocardial PET imaging using combined PET/MRI. J Nucl Cardiol 2019;26:1107‐18.

    Article  PubMed  Google Scholar 

  12. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307‐10.

    Article  CAS  PubMed  Google Scholar 

  13. Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb) 2015;25:141‐51.

    Article  PubMed  Google Scholar 

  14. Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ, et al. Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J 2014;168:721‐30.

    Article  PubMed  Google Scholar 

  15. Meta-analysis Global Group in Chronic Heart F. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: An individual patient data meta-analysis. Eur Heart J 2012;33:1750-7.

  16. Clarke CL, Grunwald GK, Allen LA, Baron AE, Peterson PN, Brand DW, et al. Natural history of left ventricular ejection fraction in patients with heart failure. Circ Cardiovasc Qual Outcomes 2013;6:680‐6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dunlay SM, Roger VL, Weston SA, Jiang R, Redfield MM. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail 2012;5:720‐6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hsu JJ, Ziaeian B, Fonarow GC. Heart failure with mid-range (borderline) ejection fraction: Clinical implications and future directions. JACC Heart Fail 2017;5:763‐71.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Slart RH, Bax JJ, de Jong RM, de Boer J, Lamb HJ, Mook PH, et al. Comparison of gated PET with MRI for evaluation of left ventricular function in patients with coronary artery disease. J Nucl Med 2004;45:176‐82.

    PubMed  Google Scholar 

  20. Yao Y, Wang DW, Fang W, Tian YQ, Shen R, Sun XX, et al. Evaluation of left ventricular volumes and ejection fraction by (99m)Tc-MIBI gated SPECT and (18)F-FDG gated PET in patients with prior myocardial infarction. J Nucl Cardiol 2021;28:560‐74.

    Article  PubMed  Google Scholar 

  21. Schaefer WM, Lipke CS, Nowak B, Kaiser HJ, Buecker A, Krombach GA, et al. Validation of an evaluation routine for left ventricular volumes, ejection fraction and wall motion from gated cardiac FDG PET: A comparison with cardiac magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2003;30:545‐53.

    Article  PubMed  Google Scholar 

  22. Shukla AK, Kumar U. Positron emission tomography: An overview. J Med Phys 2006;31:13‐21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Beitner N, Jenner J, Sorensson P. Comparison of left ventricular volumes measured by 3DE, SPECT and CMR. J Cardiovasc Imaging 2019;27:200‐11.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Persson E, Carlsson M, Palmer J, Pahlm O, Arheden H. Evaluation of left ventricular volumes and ejection fraction by automated gated myocardial SPECT versus cardiovascular magnetic resonance. Clin Physiol Funct Imaging 2005;25:135‐41.

    Article  PubMed  Google Scholar 

  25. Nakajima K, Okuda K, Nystrom K, Richter J, Minarik D, Wakabayashi H, et al. Improved quantification of small hearts for gated myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2013;40:1163‐70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Scheffler K, Lehnhardt S. Principles and applications of balanced SSFP techniques. Eur Radiol 2003;13:2409‐18.

    Article  PubMed  Google Scholar 

  27. Kumita S, Cho K, Nakajo H, Toba M, Uwamori M, Mizumura S, et al. Assessment of left ventricular diastolic function with electrocardiography-gated myocardial perfusion SPECT: Comparison with multigated equilibrium radionuclide angiography. J Nucl Cardiol 2001;8:568‐74.

    Article  CAS  PubMed  Google Scholar 

  28. Vourvouri EC, Poldermans D, Bax JJ, Sianos G, Sozzi FB, Schinkel AF, et al. Evaluation of left ventricular function and volumes in patients with ischaemic cardiomyopathy: Gated single-photon emission computed tomography versus two-dimensional echocardiography. Eur J Nucl Med 2001;28:1610‐5.

    Article  CAS  PubMed  Google Scholar 

  29. Leoncini M, Marcucci G, Sciagra R, Frascarelli F, Traini AM, Mondanelli D, et al. Nitrate-enhanced gated technetium 99m sestamibi SPECT for evaluating regional wall motion at baseline and during low-dose dobutamine infusion in patients with chronic coronary artery disease and left ventricular dysfunction: Comparison with two-dimensional echocardiography. J Nucl Cardiol 2000;7:426‐31.

    Article  CAS  PubMed  Google Scholar 

  30. Nazir MS, Gould SM, Milidonis X, Reyes E, Ismail TF, Neji R, et al. Simultaneous (13)N-Ammonia and gadolinium first-pass myocardial perfusion with quantitative hybrid PET-MR imaging: A phantom and clinical feasibility study. Eur J Hybrid Imaging 2019;3:15.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nazir MS, Ismail TF, Reyes E, Chiribiri A, Kaufmann PA, Plein S. Hybrid positron emission tomography-magnetic resonance of the heart: Current state of the art and future applications. Eur Heart J Cardiovasc Imaging 2018;19:962‐74.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors would like to thank Freya Klein, Marlena Hofbauer, Melanie Thüringer, Michele Hug, and Sabrina Epp for their excellent support.

Funding

This work was supported by a grant from the Swiss National Science Foundation (SNSF, Project No. 175640) and the Iten-Kohaut Foundation.

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Author notes

  1. Ronny R. Buechel and Tobias A. Fuchs: shared last authorship.

Authors and Affiliations

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

    Alexander Maurer MD, Aleksandra Sustar MD, Andreas A. Giannopoulos MD, PhD, Hannes Grünig MD, Adam Bakula MD, Dimitri Patriki MD, Elia von Felten MD, Michael Messerli, Aju P. Pazhenkottil MD, Catherine Gebhard MD, PhD, Philipp A. Kaufmann MD, Ronny R. Buechel MD & Tobias A. Fuchs MD

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Correspondence to Tobias A. Fuchs MD.

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Disclosures

The authors—Alexander Maurer, Aleksandra Sustar, Hannes Grünig, Adam Bakula, Dimitri Patriki, Elia von Felten, Michael Messerli, Aju P Pazhenkottil, Andreas A Giannopoulos, Catherine Gebhard, Philipp A Kaufmann, and Tobias A Fuchs—have no personal conflicts of interest to declare. Ronny R Buechel has received honoraria from Pfizer and GE Healthcare. The University Hospital Zurich holds a research agreement with GE Healthcare.

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Supplementary file1 (PPTX 503 kb)

Supplement 1:

Scatterplots with linear correlation and regression analysis of underestimation of LV volumes in [13N]-ammonia-PET MPI relative to CMR as a function of estimated heart size (CMR LVEDV). a), b) & c) show the significant increasing underestimation of LV volume in [13N]-ammonia-PET MPI for increasing heart size for LVESV, LVEDV and LVSV respectively. Supplementary file2 (DOCX 286 kb)

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Maurer, A., Sustar, A., Giannopoulos, A.A. et al. Left ventricular function and volumes from gated [13N]-ammonia positron emission tomography myocardial perfusion imaging: A prospective head-to-head comparison against CMR using a hybrid PET/MR device. J. Nucl. Cardiol. 30, 616–625 (2023). https://doi.org/10.1007/s12350-022-03029-x

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