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Yamamoto A, Nagao M, Kawakubo M, Nakao R, Matsuo Y, Sakai A, Kaneko K, Fukushima K, Momose M, Sakai S, Yamaguchi J. Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease. Radiol Cardiothorac Imaging 2024; 6:e230298. [PMID: 38814185 DOI: 10.1148/ryct.230298] [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] [Indexed: 05/31/2024]
Abstract
Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Atsushi Yamamoto
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Michinobu Nagao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Masateru Kawakubo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Risako Nakao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Yuka Matsuo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Akiko Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Koichiro Kaneko
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Kenji Fukushima
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Mitsuru Momose
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Shuji Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Junichi Yamaguchi
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
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Nagao M, Kawakubo M, Yamamoto A, Nakao R, Matsuo Y, Fukushima K, Sakai A, Momose M, Sakai S. Myocardial Strain Derived from 13N-ammonia Positron Emission Tomography: Detection of Ischemia-Related Wall Motion Abnormality. ANNALS OF NUCLEAR CARDIOLOGY 2023; 9:26-32. [PMID: 38058577 PMCID: PMC10696145 DOI: 10.17996/anc.22-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 12/08/2023]
Abstract
Background: Due to the limitation of spatial resolution, cardiac nuclear medicine images have not been applied to feature-tracking method to automatic extraction of myocardial contours. We have successfully applied the feature-tracking method to high-resolution cine 13N-ammonia positron emission tomography (PET) images to calculate the regional myocardial strains. Here, we investigate the potential of 13N-ammonia PET-derived strain to detect ischemia-related wall motion abnormality. Methods: Data of adenosine-stress/rest 13N-ammonia PET for 95 coronary artery disease patients was retrospectively analyzed. Using an original algorithm dedicated to 13N-ammonia PET, the longitudinal strain (LS) corresponding to the three main coronary artery territories [right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex coronary artery (LCX)] was calculated from semi-automatic endocardial contours extraction on cine 13N-ammonia PET images of the left ventricular long-axis. The presence of ischemia in three main territories was determined from rest and stress-perfusion images. Results: In all three coronary territories, LS at stress was significantly smaller at rest in the ischemic region RCA: -19.2±8.0% vs. -22.7±6.1%, LAD: -19.0±6.9% vs. -24.4±6.4%, LCX: -20.5%±7.6% vs. -22.6±6.9%). In contrast, in the non-ischemic region, there was no significant difference between the LS at stress and at rest. Receiver-operating-characteristic analysis revealed that using the optimal cutoff of the LS ratio of stress to rest, ischemia could be diagnosed with area under the curve of 0.82 in the RCA, 0.86 in the LAD, and 0.69 in the LCX. Conclusions: Myocardial strain derived from endocardial feature-tracking of 13N-ammonia PET cine imaging is reduced in the ischemia induced by adenosine-stress. The LS ratio of stress to rest may detect wall motion abnormality related to ischemia.
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Affiliation(s)
- Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Fukushima
- Department of Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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