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Simões JLB, Braga GDC, Mittelmann TH, Bagatini MD. Current Pharmacology and Modulation of the Purinergic System in Takotsubo Syndrome Triggered by Cytokine Storm. Curr Probl Cardiol 2024; 49:102019. [PMID: 37544631 DOI: 10.1016/j.cpcardiol.2023.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Studies show that with the COVID-19 pandemic, the world's population went through multiple stress and anxiety factors, generating serious psychological problems, in addition, the virus also caused damage and physical stress to those contaminated. In this way, the intense emotional experiences and stressful effects on the body caused by SARS-CoV-2 are capable of triggering the excessive release of catecholamines in the body. Thus, the framework of Takotsubo Syndrome is characterized by myocardial dysfunction as a response of cardiac receptors to the spillage of such hormones in an unregulated way in the human body. The purinergic system plays a central role in this process, as it actively participates in actions responsible for the syndromic cascade, such as the stress generated by the cytokine storm triggered by the virus and the stimulation of deregulated catecholamine release. Therefore, further pharmacological studies on the role of purines in this pathology should be developed in order to avoid the evolution of the syndrome and to modulate its P1 and P2 receptors aiming at developing means of reversing or treating the Takotsubo Syndrome.
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Mallet F, Poitrasson-Rivière A, Mariano-Goulart D, Agostini D, Manrique A. Measuring myocardial blood flow using dynamic myocardial perfusion SPECT: artifacts and pitfalls. J Nucl Cardiol 2023; 30:2006-2017. [PMID: 36598748 DOI: 10.1007/s12350-022-03165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/09/2022] [Indexed: 01/05/2023]
Abstract
Dynamic acquisition allows absolute quantification of myocardial perfusion and flow reserve, offering an alternative to overcome the potential limits of relative quantification, especially in patients with balanced multivessel coronary artery disease. SPECT myocardial perfusion is widely available, at lower cost than PET. Dynamic cardiac SPECT is now feasible and has the potential to be the next step of comprehensive perfusion imaging. In order to help nuclear cardiologists potentially interested in using dynamic perfusion SPECT, we sought to review the different steps of acquisition, processing, and reporting of dynamic SPECT studies in order to enlighten the potentially critical pitfalls and artifacts. Both patient-related and technical artifacts are discussed. Key parameters of the acquisition include pharmacological stress, radiopharmaceuticals, and injection device. When it comes to image processing, attention must be paid to image-derived input function, patient motion, and extra-cardiac activity. This review also mentions compartment models, cameras, and attenuation correction. Finally, published data enlighten some facets of dynamic cardiac SPECT while several issues remain. Harmonizing acquisition and quality control procedures will likely improve its performance and clinical strength.
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Affiliation(s)
- Florian Mallet
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
- Department of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | | | - Denis Mariano-Goulart
- Department of Nuclear Medicine, CHU of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Denis Agostini
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France.
- GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France.
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Gibarti C, Murín P, Huňavý M, Koribský R, Urban L, Studenčan M, Gál P. Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison. Exp Ther Med 2023; 25:192. [PMID: 37020529 PMCID: PMC10068412 DOI: 10.3892/etm.2023.11891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023] Open
Abstract
Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East-Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non-invasive diagnosis of symptomatic patients with a low to moderate pre-test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.
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Affiliation(s)
- Claudia Gibarti
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Pavol Murín
- Department of First Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Mikuláš Huňavý
- Department of First Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Roman Koribský
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Lukáš Urban
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia
| | - Martin Studenčan
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Peter Gál
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia
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Improving Detection of CAD and Prognosis with PET/CT Quantitative Absolute Myocardial Blood Flow Measurements. Curr Cardiol Rep 2022; 24:1855-1864. [PMID: 36348147 DOI: 10.1007/s11886-022-01805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the role of PET MPI in the detection of CAD, focussing on the added value of MBF for diagnosis and prognostication. RECENT FINDINGS Positron emission tomography (PET) myocardial perfusion imaging (MPI) is increasingly used for the risk stratification of patients with suspected or established coronary artery disease (CAD). PET MPI provides accurate and reproducible non-invasive quantification of myocardial blood flow (MBF) at rest and during hyperemia, providing incremental information over conventional myocardial perfusion alone. Inclusion of MBF in PET MPI interpretation improves both its sensitivity and specificity. Moreover, quantitative MBF measurements have repeatedly been shown to offer incremental and independent prognostic information over conventional clinical markers in a broad range of conditions, including in CAD. Quantitative MBF measurement is now an established and powerful tool enabling accurate risk stratification and guiding patients' management. The role of PET MPI and flow quantification in cardiac allograft vasculopathy (CAV), which represents a particular form of CAD, will also be reviewed.
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Frey SM, Honegger U, Clerc OF, Caobelli F, Haaf P, Zellweger MJ. Left ventricular ejection fraction, myocardial blood flow and hemodynamic variables in adenosine and regadenoson vasodilator 82-Rubidium PET. J Nucl Cardiol 2022; 29:921-933. [PMID: 34386864 DOI: 10.1007/s12350-021-02729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/16/2021] [Indexed: 02/04/2023]
Abstract
AIMS In most Rubidium-(Rb)-positron emission tomography (PET) studies, dipyridamole was used as vasodilator. The aim was to evaluate vasodilator PET left ventricular ejection fraction (LVEF), myocardial blood flow (MBF), hemodynamics, and the influence of adenosine and regadenoson on these variables. METHODS AND RESULTS Consecutive patients (N = 2299) with prior coronary artery disease (CAD) or no prior CAD undergoing adenosine/regadenoson 82Rb-PET were studied and compared according to CAD status and normal/abnormal PET (summed stress score 0-3 vs. ≥4). Rest and stress LVEF differed significantly depending on CAD status and scan results. In patients with no prior CAD, rest/stress LVEF were 68% and 72%, in patients with prior CAD 60% and 63%. LVEF during stress increased 5 ± 6% in normal compared to 1 ± 8% in abnormal PET (P<0.001). Global rest myocardial blood flow(rMBF), stress MBF(sMBF) and myocardial flow reserve (sMBF/rMBF) were significantly higher in no prior CAD patients compared to prior CAD patients(1.3 ± 0.5, 3.3 ± 0.9, 2.6 ± 0.8 and 1.2 ± 0.4, 2.6 ± 0.8, 2.4 ± 0.8 ml/g/min, respectively, P<0.001) and in normal versus abnormal scans, irrespective of CAD status(no prior CAD: 1.4 ± 0.5, 3.5 ± 0.8, 2.8 ± 0.8 and 1.2 ± 0.8, 2.5 ± 0.8, 2.2 ± 0.7; prior CAD: 1.3 ± 0.4, 3.1 ± 0.8, 2.7 ± 0.8 and 1.1 ± 0.4, 2.3 ± 0.7, 2.2 ± 0.7 ml/g/min, respectively, P<0.001). LVEF and hemodynamic values were similar for adenosine and regadenoson stress. Stress LVEF ≥70% excluded relevant ischemia (≥10%) with a negative predictive value (NPV) of 94% (CI 92-95%). CONCLUSIONS Rest/stress LVEF, LVEF reserve and MBF values are lower in abnormal compared to normal scans. Adenosine and regadenoson seem to have similar effect on stress LVEF, MBF and hemodynamics. A stress LVEF ≥70% has a high NPV to exclude relevant ischemia.
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Affiliation(s)
- Simon M Frey
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Olivier F Clerc
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Federico Caobelli
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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Mannarino T, Gaudieri V, Acampa W. Vasodilators and myocardial blood flow by CZT cameras: Make us see further. J Nucl Cardiol 2022; 29:123-125. [PMID: 33205326 DOI: 10.1007/s12350-020-02369-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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Kero T, Saraste A, Lagerqvist B, Sörensen J, Pikkarainen E, Lubberink M, Knuuti J. Quantitative myocardial perfusion response to adenosine and regadenoson in patients with suspected coronary artery disease. J Nucl Cardiol 2022; 29:24-36. [PMID: 34386859 PMCID: PMC8873130 DOI: 10.1007/s12350-021-02731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The aim of the present study was to compare the quantitative flow responses of regadenoson against adenosine using cardiac 15O-water PET imaging in patients with suspected or known coronary artery disease (CAD). METHODS Hyperemic myocardial blood flow (MBF) after adenosine and regadenoson was compared using correlation and Bland-Altman analysis in 21 patients who underwent rest and adenosine 15O-water PET scans followed by rest and regadenoson 15O-water PET scans. RESULTS Global mean (± SD) MBF values at rest and stress were 0.92 ± 0.27 and 2.68 ± 0.80 mL·g·min for the adenosine study and 0.95 ± 0.29 and 2.76 ± 0.79 mL·g·min for the regadenoson study (P = 0.55 and P = 0.49). The correlations between global and regional adenosine- and regadenoson-based stress MBF were strong (r = 0.80 and r = 0.77). The biases were small for both global and regional MBF comparisons (0.08 and 0.09 mL·min·g), but the limits of agreement were wide for stress MBF. CONCLUSION The correlation between regadenoson- and adenosine-induced hyperemic MBF was strong but the agreement was only moderate indicating that established cut-off values for 150-water PET should be used cautiously if using regadenoson as vasodilator.
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Affiliation(s)
- Tanja Kero
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden.
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - Antti Saraste
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Bo Lagerqvist
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Essi Pikkarainen
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Juhani Knuuti
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
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Brana Q, Thibault F, Courtehoux M, Metrard G, Ribeiro MJ, Angoulvant D, Bailly M. Regadenoson versus dipyridamole: Evaluation of stress myocardial blood flow response on a CZT-SPECT camera. J Nucl Cardiol 2022; 29:113-122. [PMID: 32651801 DOI: 10.1007/s12350-020-02271-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Regadenoson is a selective adenosine receptor agonist. It is currently unclear if the level of hyperemia differs between stress agents. We compared Myocardial Blood Flow (MBF) and Myocardial Flow Reserve (MFR) response on CZT-SPECT Myocardial Perfusion Imaging (MPI) to evaluate if dipyridamole and regadenoson could induce the same level of hyperemia. METHODS 228 patients with dynamic CZT-SPECT MPI were retrospectively analyzed (66 patients stressed with regadenoson and 162 with dipyridamole) in terms of MBF and MFR. To rule out confounding factors, two groups of 41 patients were matched for clinical characteristics in a sub-analysis, excluding high cardiovascular risk patients. RESULTS Overall stress MBF was higher in regadenoson patients (1.71 ± 0.73 vs. 1.44 ± 0.55 mL·min-1·g-1 for regadenoson and dipyridamole, respectively, p < .05). However, when confounding factors were ruled out, stress MBF (1.57 ± 0.56 vs. 1.61 ± 0.62 mL·min-1·g-1 for dipyridamole and regadenoson, respectively, p = .88) and MFR (2.62 ± 0.77 vs. 2.46 ± 0.76 for dipyridamole and regadenoson, respectively, p = .40) were not different between regadenoson and dipyridamole. CONCLUSIONS Our results suggest that dipyridamole and regadenoson induce equivalent hyperemia in dynamic SPECT with similar stress MBF and MFR in comparable patients.
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Affiliation(s)
- Quentin Brana
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
- Nuclear Medicine Department, CHRU TOURS, Tours, France
| | - Frédérique Thibault
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Denis Angoulvant
- Cardiology Department, CHRU TOURS & EA4245 T2i, Tours University, Tours, France
| | - Matthieu Bailly
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France.
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Elkholy KO, Hegazy O, Okunade A, Aktas S, Ajibawo T. Regadenoson Stress Testing: A Comprehensive Review With a Focused Update. Cureus 2021; 13:e12940. [PMID: 33654619 PMCID: PMC7909893 DOI: 10.7759/cureus.12940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Regadenoson is a pharmacological stress agent that has been widely used since its approval by the Food and Drug Administration (FDA) in 2008. For many years, dipyridamole and adenosine, which are non-selective adenosine receptor agonists, were more popular. However, these agents are less preferred now due to their undesirable adverse effects as compared to regadenoson. In the ADVANCE (ADenoscan Versus regAdenosoN Comparative Evaluation) phase 3 clinical trial, regadenoson demonstrated non-inferiority to adenosine for detecting reversible myocardial ischemia. This review summarizes the clinical utilities of regadenoson as the most widely used pharmacological stress agent. Moreover, the use of regadenoson has been documented in specific patient populations. Although regadenoson has established safety and efficacy in most patients with chronic diseases, there are equivocal results in the literature for other chronic diseases. It is warranted to highlight that the use of regadenoson has not been studied in patients of low socioeconomic class; it is a condition that carries a significant burden on the cardiovascular system.
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Affiliation(s)
- Karim O Elkholy
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Omar Hegazy
- Internal Medicine, Mercy Hospital, Chicago, USA
| | - Adeniyi Okunade
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Suat Aktas
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Harel F, Finnerty V, Authier S, Pelletier-Galarneau M. Comparison of two dipyridamole infusion protocols for myocardial perfusion imaging in subjects with low likelihood of significant obstructive coronary artery disease. J Nucl Cardiol 2020; 27:1820-1828. [PMID: 30367380 DOI: 10.1007/s12350-018-01478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) with positron emission tomography allows accurate measurements of myocardial blood flow (MBF). Stress MBF thresholds have been proposed to provide diagnostic and prognostic information in different pathology. Most studies relying on dipyridamole use a 5-minute infusion protocol, while current guidelines recommend a 4-minute infusion. The purpose of this study is to compare the effects of different dipyridamole infusion times on stress MBF. METHODS The charts of 2,207 patients who underwent rubidium-82 MPI were retrospectively reviewed and 147 subjects with low likelihood of significant coronary artery disease (CAD) defined as calcium score = 0, body mass index < 45 kg·m-2, and summed stress score ≤ 3 were included. Of those, 65 were imaged with a 4-minute dipyridamole infusion (0.56 mg·kg-1) protocol and 82 with a 5-minute protocol (0.70 mg·kg-1). RESULTS Stress MBF (3.23±0.76 vs 3.02±0.71 mL·min-1·g-1, P = 0.09), myocardial flow reserve (2.70±0.67 vs 2.85±0.74, P = 0.20), and coronary vascular resistance index (30±10 vs 31±9 mmHg × g × min·mL-1, P = 0.38) were not significantly different between the two protocols. The 5-minute protocol was associated with higher prevalence of symptoms (92.7% vs 81.5%, P = 0.04) and greater decrease in systolic blood pressure (- 9 vs - 6 mmHg, P = 0.03). CONCLUSIONS The 4-minute and 5-minute dipyridamole infusion protocols produce comparable myocardial flow response, hemodynamic changes, and symptoms, in subjects with low likelihood of significant obstructive CAD.
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Affiliation(s)
- Francois Harel
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Vincent Finnerty
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Sébastien Authier
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Matthieu Pelletier-Galarneau
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada.
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12
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Packard RRS. Dipyridamole infusion protocols for absolute myocardial blood flow quantitation by PET. J Nucl Cardiol 2020; 27:1829-1831. [PMID: 30515747 DOI: 10.1007/s12350-018-01554-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA.
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13
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Bajaj NS, Singh A, Zhou W, Gupta A, Fujikura K, Byrne C, Harms HJ, Osborne MT, Bravo P, Andrikopolou E, Divakaran S, Bibbo CF, Hainer J, Skali H, Taqueti V, Steigner M, Dorbala S, Charytan DM, Prabhu SD, Blankstein R, Deo RC, Solomon SD, Di Carli MF. Coronary Microvascular Dysfunction, Left Ventricular Remodeling, and Clinical Outcomes in Patients With Chronic Kidney Impairment. Circulation 2019; 141:21-33. [PMID: 31779467 DOI: 10.1161/circulationaha.119.043916] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiac dysfunction and cardiovascular events are prevalent among patients with chronic kidney disease without overt obstructive coronary artery disease, but the mechanisms remain poorly understood. Coronary microvascular dysfunction has been proposed as a link between abnormal renal function and impairment of cardiac function and cardiovascular events. We aimed to investigate the relations between chronic kidney disease, coronary microvascular dysfunction, cardiac dysfunction, and adverse cardiovascular outcomes. METHODS Patients undergoing cardiac stress positron emission tomography, echocardiogram, and renal function ascertainment at Brigham and Women's Hospital were studied longitudinally. Patients free of overt coronary (summed stress score <3 and without a history of ischemic heart disease), valvular, and end-organ disease were followed up for the adverse composite outcome of death or hospitalization for myocardial infarction or heart failure. Coronary flow reserve (CFR) was determined from positron emission tomography. Echocardiograms were used to measure cardiac mechanics: diastolic (lateral and septal E/e') and systolic (global longitudinal, radial, and circumferential strain). Image analyses and event adjudication were blinded. The associations between estimated glomerular filtration rate (eGFR), CFR, diastolic and systolic indices, and adverse cardiovascular outcomes were assessed in adjusted models and mediation analyses. RESULTS Of the 352 patients (median age, 65 years; 63% female; 22% black) studied, 35% had an eGFR <60 mL·min-1·1.73 m-2, a median left ventricular ejection fraction of 62%, and a median CFR of 1.8. eGFR and CFR were associated with diastolic and systolic indices, as well as future cardiovascular events (all P<0.05). In multivariable models, CFR, but not eGFR, was independently associated with cardiac mechanics and cardiovascular events. The associations between eGFR, cardiac mechanics, and cardiovascular events were partly mediated via CFR. CONCLUSIONS Coronary microvascular dysfunction, but not eGFR, was independently associated with abnormal cardiac mechanics and an increased risk of cardiovascular events. Coronary microvascular dysfunction may mediate the effect of chronic kidney disease on abnormal cardiac function and cardiovascular events in those without overt coronary artery disease.
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Affiliation(s)
- Navkaranbir S Bajaj
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.).,Division of Cardiovascular Disease, Department of Internal Medicine, and Department of Radiology, University of Alabama at Birmingham (N.S.B., S.D.P.)
| | - Amitoj Singh
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Wunan Zhou
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Ankur Gupta
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Kana Fujikura
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Christina Byrne
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Hendrik J Harms
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Michael T Osborne
- Cardiac MR/PET/CT Program, Department of Radiology, Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (M.T.O.)
| | - Paco Bravo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Efstathia Andrikopolou
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Courtney F Bibbo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Viviany Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Michael Steigner
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - David M Charytan
- Nephrology Division, New York University School of Medicine, New York (D.M.C.)
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, Department of Internal Medicine, and Department of Radiology, University of Alabama at Birmingham (N.S.B., S.D.P.)
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Rahul C Deo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Scott D Solomon
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.)
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14
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Koenders SS, van Dijk JD, Jager PL, Ottervanger JP, Slump CH, van Dalen JA. Impact of regadenoson-induced myocardial creep on dynamic Rubidium-82 PET myocardial blood flow quantification. J Nucl Cardiol 2019; 26:719-728. [PMID: 30788758 PMCID: PMC6517358 DOI: 10.1007/s12350-019-01649-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repositioning of the heart during myocardial perfusion imaging (MPI) using Rubidium-82 (Rb-82) PET may occur when using regadenoson. Our aim was to determine the prevalence and the effect of correcting for this myocardial creep on myocardial blood flow (MBF) quantification. METHODS We retrospectively included 119 consecutive patients who underwent dynamic rest- and regadenoson-induced stress MPI using Rb-82 PET. The presence of myocardial creep was visually assessed in the dynamic stress PET series by identifying differences between the automatically drawn myocardium contour and the activity. Uncorrected and corrected stress MBFs were compared for the three vascular territories (LAD, LCX, and RCA) and for the whole myocardium. RESULTS Myocardial creep was observed in 52% of the patients during stress. Mean MBF values decreased after correction in the RCA from 4.0 to 2.7 mL/min/g (P < 0.001), in the whole myocardium from 2.7 to 2.6 mL/min/g (P = 0.01), and increased in the LAD from 2.5 to 2.6 mL/min/g (P = 0.03) and remained comparable in the LCX (P = 0.3). CONCLUSIONS Myocardial creep is a frequent phenomenon when performing regadenoson-induced stress Rb-82 PET and has a significant impact on MBF values, especially in the RCA territory. As this may hamper diagnostic accuracy, myocardial creep correction seems necessary for reliable quantification.
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Affiliation(s)
- S S Koenders
- Department of Nuclear Medicine, Isala hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - J D van Dijk
- Department of Nuclear Medicine, Isala hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - C H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands
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15
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Bouallçgue FB, Nganoa C, Vigne J, Agostini D, Manrique A. Comparative Performances of Dipyridamole and Regadenoson to Detect Myocardial Ischemia using Cardiac Cadmium-Zinc-Telluride Single-Photon Emission Computerized Tomography. J Clin Imaging Sci 2018; 8:51. [PMID: 30546935 PMCID: PMC6251245 DOI: 10.4103/jcis.jcis_71_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 08/21/2018] [Indexed: 11/09/2022] Open
Abstract
Objective: We evaluated the relative performances of dipyridamole (Dip) and regadenoson (Reg) in a cohort of patients referred for coronary artery disease diagnosis or follow-up using myocardial perfusion imaging. Materials and Methods: We retrospectively included 515 consecutive patients referred for 99mTc-sestamibi myocardial perfusion single-photon emission computerized tomography (SPECT) on a cadmium-zinc-telluride (CZT) camera after pharmacologic stress. About three quarters (n = 391, 76%) received Dip. Reg was administrated to patients with chronical respiratory disease or with body mass index (BMI) over 38 kg/m2 (n = 124, 24%). Patients with an abnormal stress scan (92%) underwent a rest imaging on the same day. Qualitative interpretation of perfusion images was achieved using QPS software, and the ischemic area was assessed using the 17-segment model. In patients undergoing a stress-rest protocol, perfusion polar plots were postprocessed using automated in-house software to quantify the extension, intensity, and location of the reversible perfusion defect. Statistical comparison between groups was performed using univariate and multivariate analysis. Results: Qualitative analysis concluded to myocardial ischemia in 70% of the patients (69% in the Dip group, 76% in the Reg group, P = ns). In those patients, the number of involved segments (Dip 2.5 ± 1.6, Reg 2.7 ± 1.6, P = ns) and the proportion of patients with an ischemic area larger than two segments (Dip 30%, Reg 37%, P = ns) were comparable. Automated quantification of the reversible perfusion defect demonstrated similar defect extension, intensity, and severity in the two groups. Defect location was identical at the myocardial segment and vascular territory scales. Conclusions: Reg and Dip showed equal performances for ischemic burden characterization using myocardial CZT SPECT.
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Affiliation(s)
- Fayçal Ben Bouallçgue
- Department of Nuclear Medicine, Montpellier University Hospital, Caen, France.,PhyMedExp, INSERM - CNRS, Montpellier University, Montpellier, Caen, France.,Department of Nuclear Medicine, CHU de Caen, Caen, France
| | | | - Jonathan Vigne
- Department of Nuclear Medicine, CHU de Caen, Caen, France
| | - Denis Agostini
- Department of Nuclear Medicine, CHU de Caen, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU de Caen, Caen, France.,Normandie University, UNICAEN, EA 4650 SEILIRM, GIP Cyceron, Caen, France
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16
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Klein R, Ocneanu A, deKemp RA. Time-frame sampling for 82Rb PET flow quantification: Towards standardization of clinical protocols. J Nucl Cardiol 2017; 24:1530-1534. [PMID: 28687966 DOI: 10.1007/s12350-017-0981-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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17
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Packard RRS, Maddahi J. Regadenoson-induced hyperemia for absolute myocardial blood flow quantitation by 13N-ammonia PET and detection of cardiac allograft vasculopathy. J Nucl Cardiol 2017; 24:1145-1148. [PMID: 28138814 DOI: 10.1007/s12350-016-0763-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jamshid Maddahi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Nuclear Medicine Clinic, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, 100 Medical Plaza, Suite 410, Los Angeles, CA, 90095, USA.
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18
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Amer KA, Hurren JR, Edwin SB, Cohen G. Regadenoson versus Dipyridamole: A Comparison of the Frequency of Adverse Events in Patients Undergoing Myocardial Perfusion Imaging. Pharmacotherapy 2017; 37:657-661. [DOI: 10.1002/phar.1940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kallie A. Amer
- Department of Pharmacy Services; St John Hospital and Medical Center; Detroit Michigan
| | - Jeff R. Hurren
- Department of Pharmacy Services; St John Hospital and Medical Center; Detroit Michigan
| | - Stephanie B. Edwin
- Department of Pharmacy Services; St John Hospital and Medical Center; Detroit Michigan
| | - Gerald Cohen
- Non-Invasive Cardiology Laboratory; St John Hospital and Medical Center; Detroit Michigan
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Brophey MD, Farukhi IM, Castanon R, DeLaPena R, Bradshaw L, Banerjee S. Accuracy of 82Rb PET/CT Myocardial Perfusion Imaging with Regadenoson Stress, Including 3-Year Clinical Outcomes. J Nucl Med Technol 2017; 45:75-81. [PMID: 28408703 DOI: 10.2967/jnmt.116.188938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine the clinical accuracy of 82Rb PET/CT myocardial perfusion imaging (MPI) when performed with regadenoson stress in a U.S. Department of Veterans Affairs (VA) population of patients. Methods: The initial cohort of 480 patients undergoing vasodilator PET MPI with regadenoson stress at our institution from September 2009 through July 2010 was closely tracked for short-term outcomes based on correlation with invasive coronary catheterization. Long-term outcomes were determined by major adverse cardiac event rates based on data extraction from the electronic medical record and grouped by summed stress score (SSS) for a 3-y period. Results: At the 3-y follow-up, there had been 31 patient deaths, 5 of which were heart-related. Twenty-four patients had documented myocardial infarctions. Event rates and cardiac death rates were highly predicted by the results of PET MPI. Seventy patients underwent invasive cardiac catheterization within 60 d of the PET MPI. Patients were increasingly likely to undergo catheterization as their SSS increased. Catheterization correlation demonstrated a sensitivity of 95%, a positive predictive value of 88.4% for significant coronary artery disease, and an overall accuracy of 86% for PET MPI with regadenoson stress when compared with invasive catheterization. Conclusion: PET MPI with regadenoson stress demonstrates high accuracy when correlated with invasive catheterization and clinical outcomes. The SSS was highly predictive of cardiac events and patient survival in a VA population over a 3-y period of clinical follow-up.
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Affiliation(s)
- Michael D Brophey
- Nuclear Medicine Service, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas
| | - Irfan M Farukhi
- Nuclear Medicine Service, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas
| | - Rosinda Castanon
- Nuclear Medicine Service, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas
| | - Rosinda DeLaPena
- Nuclear Medicine Service, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas
| | - Ledjona Bradshaw
- Research Department, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas; and
| | - Subhash Banerjee
- Cardiology Section, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, Texas
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20
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Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:1530-45. [PMID: 26846913 DOI: 10.1007/s00259-016-3317-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 02/06/2023]
Abstract
Until recently, PET was regarded as a luxurious way of performing myocardial perfusion scintigraphy, with excellent image quality and diagnostic capabilities that hardly justified the additional cost and procedural effort. Quantitative perfusion PET was considered a major improvement over standard qualitative imaging, because it allows the measurement of parameters not otherwise available, but for many years its use was confined to academic and research settings. In recent years, however, several factors have contributed to the renewal of interest in quantitative perfusion PET, which has become a much more readily accessible technique due to progress in hardware and the availability of dedicated and user-friendly platforms and programs. In spite of this evolution and of the growing evidence that quantitative perfusion PET can play a role in the clinical setting, there are not yet clear indications for its clinical use. Therefore, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, decided to examine the current literature on quantitative perfusion PET to (1) evaluate the rationale for its clinical use, (2) identify the main methodological requirements, (3) identify the remaining technical difficulties, (4) define the most reliable interpretation criteria, and finally (5) tentatively delineate currently acceptable and possibly appropriate clinical indications. The present position paper must be considered as a starting point aiming to promote a wider use of quantitative perfusion PET and to encourage the conception and execution of the studies needed to definitely establish its role in clinical practice.
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21
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Acampa W, Salvatore M, Cuocolo A. Prognostication in the era of a new stressor for myocardial perfusion imaging. J Nucl Cardiol 2015; 22:1222-4. [PMID: 25698479 DOI: 10.1007/s12350-015-0075-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Wanda Acampa
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy.
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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22
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Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis. Eur J Nucl Med Mol Imaging 2015; 42:1903-11. [PMID: 26194718 DOI: 10.1007/s00259-015-3129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
AIMS A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). METHODS AND RESULTS One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: "Group 1" (HRR < 8 bpm; lowest tertile); "Group 2" (8 ≤ HRR ≤ 12 bpm; middle tertile); "Group 3" (HRR >12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74-0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole ("Group 1") MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR ("Group 3") (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to "Group 3" patients, while it disappeared in those with blunted HRR. CONCLUSIONS In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD.
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Sinusas AJ. Does a Shortened Hyperemia With Regadenoson Stress Pose a Concern for Quantitative Rb-82 PET Imaging? JACC Cardiovasc Imaging 2015; 8:448-450. [DOI: 10.1016/j.jcmg.2014.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 10/23/2022]
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Johnson NP, Gould KL. Regadenoson versus dipyridamole hyperemia for cardiac PET imaging. JACC Cardiovasc Imaging 2015; 8:438-447. [PMID: 25797122 DOI: 10.1016/j.jcmg.2014.11.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The goal of this study was to compare regadenoson and dipyridamole hyperemia for quantitative myocardial perfusion imaging. BACKGROUND Regadenoson is commonly used for stress perfusion imaging. However, no study in nuclear cardiology has employed a paired design to compare quantitative hyperemic flow from regadenoson to more traditional agents such as dipyridamole. Additionally, the timing of regadenoson bolus relative to tracer administration can be expected to affect quantitative flow. METHODS Subjects underwent 2 rest/stress cardiac positron emission tomography scans using an Rb-82 generator. Each scan employed dipyridamole and a second drug in random sequence, either regadenoson according to 5 timing sequences or repeated dipyridamole. A validated retention model quantified absolute flow and coronary flow reserve. RESULTS A total of 176 pairs compared regadenoson (126 pairs, split unevenly among 5 timing sequences) or repeated dipyridamole (50 pairs). The cohort largely had few symptoms, only risk factors, and nearly normal relative uptake images, with 8% typical angina or dyspnea, 20% manifest coronary artery disease, and a minimum quadrant average of 80% (interquartile range: 76% to 83%) on dipyridamole scans. Hyperemic flow varied among regadenoson timing sequences but showed consistently lower stress flow and coronary flow reserve compared with dipyridamole. A timing sequence most similar to the regadenoson package insert achieved about 80% of dipyridamole hyperemia, whereas further delaying radiotracer injection reached approximately 90% of dipyridamole hyperemia. Because of the small numbers of pairs for each regadenoson timing protocol and a paucity of moderate or large perfusion defects, we did not observe a difference in relative uptake. CONCLUSIONS With the standard timing protocol from the package insert, regadenoson achieved only 80% of dipyridamole hyperemia quantitatively imaged by cardiac positron emission tomography using Rb-82. A nonstandard protocol using a more delayed radionuclide injection after the regadenoson bolus improved its effect to 90% of dipyridamole hyperemia.
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
| | - K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas
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Hoffmeister C, Preuss R, Weise R, Burchert W, Lindner O. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging. J Nucl Cardiol 2014; 21:1223-9. [PMID: 25124825 PMCID: PMC4228113 DOI: 10.1007/s12350-014-9952-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of beta blockers on myocardial blood flow (MBF) under vasodilators has been studied in several SPECT and PET myocardial perfusion imaging (MPI) studies with divergent results. The present study evaluated the effect of a beta blocker withdrawal on quantitative adenosine MBF and on MPI results. METHODS Twenty patients with beta blockers and CAD history were studied with quantitative adenosine N-13 ammonia PET. The first study was performed under complete medication and the second after beta blocker withdrawal. The PET studies were independently read with respect to MPI result and clinical decision making. RESULTS Global MBF showed an increase from 180.2 ± 59.9 to 193.6 ± 60.8 mL·minute(-1)/100 g (P = .02) after beta blocker withdrawal. The segmental perfusion values were closely correlated (R(2) = 0.82) over the entire range of perfusion values. An essentially different interpretation after beta blocker discontinuation was found in two cases (10%). CONCLUSION A beta blocker withdrawal induces an increase in adenosine MBF. In the majority of cases, MPI interpretation and decision making are independent of beta blocker intake. If a temporary beta blocker withdrawal before MPI is not possible or was not realized by the patient, it is appropriate to perform adenosine stress testing without loss of the essential MPI result.
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Affiliation(s)
- C. Hoffmeister
- Diabetes Center, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - R. Preuss
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - R. Weise
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - W. Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - O. Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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Jager P, Buiting M, Mouden M, Oostdijk A, Timmer J, Knollema S. Regadenoson as a new stress agent in myocardial perfusion imaging. Initial experience in The Netherlands. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jager PL, Buiting M, Mouden M, Oostdijk AHJ, Timmer J, Knollema S. [Regadenoson as a new stress agent in myocardial perfusion imaging. Initial experience in The Netherlands]. Rev Esp Med Nucl Imagen Mol 2014; 33:346-51. [PMID: 24862658 DOI: 10.1016/j.remn.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Regadenoson is a recently approved selective adenosine-2A receptor agonist to induce pharmacological stress in myocardial perfusion imaging (MPI) procedures using a single bolus injection. MATERIAL AND METHODS We included 123 patients referred for MPI because of suspected coronary arterial disease (CAD). Of these, 66 patients underwent a regadenoson stress test and 57 patients underwent an adenosine stress test preceding standard myocardial SPECT imaging. Technicians, physicians and patients were asked to report their experience using questionnaires. RESULTS As compared to adenosine, regadenoson did not produce any atrio-ventricular block (0 vs. 10% with adenosine), but did produce minor tachycardia and minimal blood pressure changes while all other side effects were milder and shorter. There were fewer patients with severe complaints after taking regadenoson than adenosine (17% vs. 32%, respectively, p<0.01). The most frequent complaint reported was dyspnea, followed by flushing and chest pain. However, when they did occur, they usually disappeared rapidly. The overall symptom score, including severity and duration of side effects, was significantly lower after regadenoson than after adenosine (6.7±6.3 vs. 10.0±7.9, respectively; p<0.01.) SPECT imaging results were similar. The regadenoson procedure was faster and more practical. CONCLUSION Regadenoson, the new selective adenosine-2A receptor agonist, is a stress agent for MPI with a patient- and department friendly profile.
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Affiliation(s)
- P L Jager
- Departamento de Medicina Nuclear, Hospital Isala, Zwolle, Holanda.
| | - M Buiting
- Departamento de Medicina Nuclear, Hospital Isala, Zwolle, Holanda
| | - M Mouden
- Departamento de Medicina Nuclear, Hospital Isala, Zwolle, Holanda; Departamento de Cardiología, Hospital Isala, Zwolle, Holanda
| | - A H J Oostdijk
- Departamento de Medicina Nuclear, Hospital Isala, Zwolle, Holanda
| | - J Timmer
- Departamento de Cardiología, Hospital Isala, Zwolle, Holanda
| | - S Knollema
- Departamento de Medicina Nuclear, Hospital Isala, Zwolle, Holanda
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Van Tosh A, Votaw JR, Reichek N, Palestro CJ, Nichols KJ. The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated (82)Rb PET myocardial perfusion imaging. J Nucl Cardiol 2013; 20:1060-8. [PMID: 24092270 PMCID: PMC4209719 DOI: 10.1007/s12350-013-9784-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gated rubidium-82 ((82)Rb) positron emission tomography (PET) imaging studies are acquired both at rest and during pharmacologic stress. Stress-induced ischemic left ventricular dysfunction (LVD) can produce a significant decrease in left ventricular ejection fraction (LVEF) from rest to stress. We determined the prevalence on PET of stress LVD with reduced ejection fraction (EF) and its association with absolute global and regional coronary flow reserve (CFR), and with relative perfusion defect summed difference score (SDS). METHODS AND RESULTS We studied 205 patients with known or suspected coronary disease (120 M, 75 F, age 69 ± 13 years) who had clinically indicated rest/regadenoson stress (82)Rb PET/CT studies. Data were acquired in dynamic gated list mode. Global and 17-segment regional CFR values were computed from first-pass flow data using a 2-compartment model and factor analysis applied to auto-generated time-activity curves. Rest and stress LVEF and SDS were quantified from gated equilibrium myocardial perfusion tomograms using Emory Cardiac Toolbox software. LVD was defined as a change in LVEF of ≤-5% from rest to stress. A subgroup of 109 patients also had coronary angiography. Stress LVD developed in 32 patients (16%), with mean EF change of -10 ± 5%, vs +6 ± 7% for patients without LVD (P < .0001). EF was similar at rest in patients with and without stress LVD (57 ± 18% vs 56 ± 16%, P = .63), but lower during stress for patients with LVD (47 ± 20% vs 61 ± 16%, P = .0001). CFR was significantly lower in patients with LVD (1.61 ± 0.67 vs 2.21 ± 1.03, Wilcoxon P = .002), and correlated significantly with change in EF (r = 0.35, P < .0001), but not with SDS (r = -0.13, P = .07). The single variable most strongly associated with high risk of CAD (i.e., left main stenosis ≥50%, LAD % stenosis ≥70%, and/or 3-vessel disease) was stress EF (χ(2) = 17.3, P < .0001). There was a higher prevalence of patients with territorial CFR values ≤1.0, consistent with coronary steal, in the LVD group than in the non-LVD group (39% vs 12%, P = .001). CONCLUSIONS LVD developed in 16% of patients undergoing (82)Rb PET myocardial perfusion imaging, and was associated with multivessel coronary artery disease. There was a significant relationship between LVD and coronary blood flow during stress, with LVD corresponding to a low CFR. Territorial CFR ≤1.0 was more common in patients with LVD than those without, suggesting that coronary steal is an important pathophysiologic mechanism contributing to pharmacologic stress-induced LVD.
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Affiliation(s)
- Andrew Van Tosh
- Research Department, Division of Cardiovascular Research, St. Francis Hospital-The Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA,
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Hsiao E, Ali B, Blankstein R, Skali H, Ali T, Bruyere J, Kwong RY, Di Carli MF, Dorbala S. Detection of obstructive coronary artery disease using regadenoson stress and 82Rb PET/CT myocardial perfusion imaging. J Nucl Med 2013; 54:1748-54. [PMID: 23940305 DOI: 10.2967/jnumed.113.120063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Our objective was to study the diagnostic performance of regadenoson (82)Rb myocardial perfusion PET imaging to detect obstructive coronary artery disease (CAD). METHODS We studied 134 patients (mean age, 63 ± 12 y; mean body mass index, 31 ± 9 kg/m(2)) without known CAD (96 with coronary angiography and 38 with low pretest likelihood of CAD). Stress left ventricular ejection fraction (LVEF) minus rest LVEF defined LVEF reserve. The Duke score was used to estimate the anatomic extent of jeopardized myocardium. RESULTS Regadenoson PET had a high sensitivity, 92% (95% confidence interval [CI], 83%-97%), in detecting obstructive CAD, with a normalcy rate of 97% (95% CI, 86%-99%), specificity of 77% (54/70 patients; 95% CI, 66%-86%), and area under the receiver-operator-characteristic curve of 0.847 (95% CI, 0.774-0.903; P < 0.001). Regadenoson PET demonstrated high sensitivity to detect CAD in patients with single-vessel CAD (89%; 95% CI, 70%-98%). The mean LVEF reserve was significantly higher in patients with normal myocardial perfusion imaging results (6.5% ± 5.4%) than in those with mild (4.3 ± 5.1, P = 0.03) and moderate to severe reversible defects (-0.2% ± 8.4%, P = 0.001). Also, mean LVEF reserve was significantly higher in patients with a low likelihood of CAD (7.2% ± 4.5%, P < 0.0001) and mild or moderate jeopardized myocardium than in those with significant jeopardized myocardium (score ≥ 6), -2.8% ± 8.3%. CONCLUSION Regadenoson (82)Rb myocardial perfusion imaging is accurate for the detection of obstructive CAD. LVEF reserve is high in patients without significant ischemia or significant angiographic jeopardized myocardium.
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Affiliation(s)
- Edward Hsiao
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and
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Cullom SJ, Case JA, Courter SA, McGhie AI, Bateman TM. Regadenoson pharmacologic rubidium-82 PET: a comparison of quantitative perfusion and function to dipyridamole. J Nucl Cardiol 2013; 20:76-83. [PMID: 23188625 DOI: 10.1007/s12350-012-9636-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dipyridamole is used for stress (82)rubidium chloride ((82)RbCl) PET because of its long hyperemic duration. Regadenoson has advantages of a fixed dose and favorable symptom profile, but its mean maximal hyperemia is only 2.3 minutes. To determine its suitability for (82)RbCl PET, we imaged subjects using a regadenoson protocol based on its hyperemic response and compared the images in the same subjects having dipyridamole PET. METHODS In 32 subjects (23 M), we assessed visually by blinded interpretation and quantitatively compared summed stress and difference scores, total perfusion deficit (TPD), LVEF, LV volumes, and change in stress-rest function. Linear correlation and Bland-Altman analysis of the paired measurements were applied for evaluation of differences. Paired t test and Pearson's correlation were applied for testing of significance. RESULTS The images were interpreted the same by visual assessment. Twenty-six (26) subjects had reversible defects; by quantitation the SSS was 12.9 ± 7.0 and 14.1 ± 6.4 (P = .23) and SDS was 7.0 ± 6.8 versus 7.6 ± 6.2 (P = .40) for dipyridamole and regadenoson, respectively. Six (6) subjects had <5% likelihood of CAD and were normal by both. All paired measurements showed a high positive correlation between regadenoson and dipyridamole; stress segmental perfusion Reg = 0.93Dip + 4.4, r = 0.88; TPD Reg = 0.94Dip + 0.41, r = 0.93; LVEF Reg = 0.92Dip + 4.7, r = 0.95; stress minus rest LVEF Reg = 0.87Dip - 0.99, r = 0.82. CONCLUSION Regadenoson stress (82)RbCl PET perfusion defect and cardiac function measurements are visually and quantitatively equivalent to dipyridamole studies and can be obtained with the clinical advantages of regadenoson.
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Affiliation(s)
- S James Cullom
- Cardiovascular Imaging Technologies, LLC, 4320 Wornall Road, Suite 55, Kansas City, MO 64111, USA.
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Comparison and effectiveness of regadenoson versus dipyridamole on stress electrocardiographic changes during positron emission tomography evaluation of patients with hypertrophic cardiomyopathy. Am J Cardiol 2012; 110:1033-9. [PMID: 22748357 DOI: 10.1016/j.amjcard.2012.05.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/23/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022]
Abstract
Dipyridamole is the most common vasodilator used with positron emission tomography for the evaluation of patients with hypertrophic cardiomyopathy (HC). The aim of this study was to evaluate whether positron emission tomographic quantification of regional myocardial perfusion (rMP), myocardial blood flow (MBF), and coronary flow reserve are comparable between dipyridamole and the newer vasodilator regadenoson in HC. An additional aim was to evaluate the association between vasodilator-induced ST-segment depression on electrocardiography and myocardial flow in HC. Nitrogen-13 ammonia positron emission tomography was performed in 57 patients with symptomatic HC at rest and during vasodilator stress (peak) with either dipyridamole (0.56 mg/kg during 4-minute infusion) or regadenoson (0.4 mg fixed bolus dose) for assessment of electrocardiographic findings, rMP (17-segment American Heart Association summed difference score), MBF, and coronary flow reserve. The dipyridamole and regadenoson groups consisted of 28 and 29 patients respectively. Baseline characteristics, including rest MBF (0.92 ± 0.22 vs 0.89 ± 0.23 ml/min/g, p = 0.60), were similar between the 2 groups. During stress, the presence and severity of abnormal rMP (summed difference score 5.5 ± 5.5 vs 5.8 ± 6.7, p = 0.80), peak MBF (1.81 ± 0.44 vs 1.82 ± 0.50 ml/min/g, p = 0.90), and coronary flow reserve (2.02 ± 0.53 vs 2.12 ± 0.12, p = 0.50) were comparable between the dipyridamole and regadenoson groups. Fewer patients exhibited side effects with regadenoson (2 vs 7, p = 0.06). Vasodilator-induced ST-segment depression showed high specificity (about 92%) but low sensitivity (about 34%) to predict abnormal rMP (summed difference score ≥2). In conclusion, measurement of rMP and quantitative flow with positron emission tomography is similar between regadenoson and dipyridamole in patients with symptomatic HC. Regadenoson is tolerated better than dipyridamole and is easier to administer. Vasodilator-induced ST-segment depression is a specific but nonsensitive marker for the prediction of abnormal rMP in patients with HC.
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Depuey EG, Mahmarian JJ, Miller TD, Einstein AJ, Hansen CL, Holly TA, Miller EJ, Polk DM, Samuel Wann L. Patient-centered imaging. J Nucl Cardiol 2012; 19:185-215. [PMID: 22328324 DOI: 10.1007/s12350-012-9523-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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DiBella EVR, Fluckiger JU, Chen L, Kim TH, Pack NA, Matthews B, Adluru G, Priester T, Kuppahally S, Jiji R, McGann C, Litwin SE. The effect of obesity on regadenoson-induced myocardial hyperemia: a quantitative magnetic resonance imaging study. Int J Cardiovasc Imaging 2011; 28:1435-44. [PMID: 21968545 PMCID: PMC3463785 DOI: 10.1007/s10554-011-9949-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/17/2011] [Indexed: 10/27/2022]
Abstract
The A2(A) receptor agonist, regadenoson, is increasingly used as a vasodilator during nuclear myocardial perfusion imaging. Regadenoson is administered as a single, fixed dose. Given the frequency of obesity in patients with symptoms of heart disease, it is important to know whether the fixed dose of regadenoson produces maximal coronary hyperemia in subjects of widely varying body size. Thirty subjects (12 female, 18 male, mean BMI 30.3 ± 6.5, range 19.6-46.6) were imaged on a 3T magnetic resonance scanner. Imaging with a saturation recovery radial turboFLASH sequence was done first at rest, then during adenosine infusion (140 μg/kg/min) and 30 min later with regadenoson (0.4 mg/5 ml bolus). A 5 cc/s injection of Gd-BOPTA was used for each perfusion sequence, with doses of 0.02, 0.03 and 0.03 mmol/kg, respectively. Analysis of the upslope of myocardial time-intensity curves and quantitative processing to obtain myocardial perfusion reserve (MPR) values were performed for each vasodilator. The tissue upslopes for adenosine and regadenoson matched closely (y = 1.1x + 0.03, r = 0.9). Mean MPR was 2.3 ± 0.6 for adenosine and 2.4 ± 0.9 for regadenoson (p = 0.14). There was good agreement between MPR measured with adenosine and regadenoson (y = 1.1x - 0.06, r = 0.7). The MPR values measured with both agents tended to be lower as BMI increased. There were no complications during administration of either agent. Regadenoson produced fewer side effects. Fixed dose regadenoson and weight adjusted adenosine produce similar measures of MPR in patients with a wide range of body sizes. Regadenoson is a potentially useful vasodilator for stress MRI studies.
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Affiliation(s)
- Edward V R DiBella
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
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