Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity

Rob S B Beanlands, Otto Muzik, Pierre Melon, Ronald Sutor, Stephen Sawada, David Muller, Diane Bondie, Gary Hutchins, Markus Schwaiger

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Objectives.: The aim of this study was to evaluate patients with coronary artery disease to 1) determine the relation between flow reserve measured by nitrogen-13 (N-13) ammonia kinetic modeling and stenosis severity assessed by quantitative angiography, and 2) examine whether flow reserve is impaired in regions supplied by vessels without significant angiographic disease. Background.: With the advent of new therapeutic approaches for coronary disease, an accurate noninvasive approach for absolute quantification of flow and flow reserve is needed to evaluate functional severity and extent of atherosclerosis. Nitrogen-13 ammonia kinetic modeling may permit such evaluation. Methods.: Twenty-seven subjects were classified into three groups: group 1 = 5 young volunteers; group 2 = 7 middle-aged volunteers; and group 3 = 15 patients with coronary artery disease. Dynamic N-13 ammonia positron emission tomographic imaging was performed at rest and during adenosine infusion. A three-compartment model was fit to regional N-13 ammonia kinetic data to determine myocardial flow. Group 3 patients underwent quantitative coronary angiography. Results.: The regional blood flow results in patients with coronary disease were classified into four subgroups: no significant detectable disease and mild (50% to 69.9% area stenosis), moderate (70% to 94.9% area stenosis) or severe (95% to 100% area stenosis) coronary disease. Flow reserve was 2.95 ± 0.65; 2.09 ± 0.47; 2.02 ± 0.51; 1.3 ± 0.32, respectively (p ≤ 0.01 except mild vs. moderate). Flow reserve was correlated with percent area stenosis (r = -0.56) and minimal lumen diameter (r = 0.75). In volunteers (groups 1 and 2), flow reserves were greater than in segments without detectable disease in group 3 patients (4.10 ± 0.71 and 3.79 ± 0.42, respectively, vs. 2.88 ± 0.56, p ≤ 0.02). Conclusions.: The functional severity of coronary disease measured by N-13 ammonia positron emission tomography varied for a given stenosis but was significantly related to angiographic severity. Among patients with coronary disease, myocardial regions without significant angiographic stenoses displayed reduced flow reserve than did regions in control subjects, indicating that vascular reactivity was more diffusely impaired in group 3 than was suggested by angiography. Noninvasive quantification of myocardial flow reserve using dynamic N-13 ammonia positron emission tomography yields important functional data that permit definition of the extent of disease even when disease is not apparent by angiography.

Original languageEnglish (US)
Pages (from-to)1465-1475
Number of pages11
JournalJournal of the American College of Cardiology
Volume26
Issue number6
DOIs
StatePublished - Nov 15 1995
Externally publishedYes

Fingerprint

Ammonia
Positron-Emission Tomography
Blood Vessels
Coronary Artery Disease
Pathologic Constriction
Nitrogen
Coronary Disease
Volunteers
Angiography
Regional Blood Flow
Coronary Angiography
Adenosine
Atherosclerosis
Electrons

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity. / Beanlands, Rob S B; Muzik, Otto; Melon, Pierre; Sutor, Ronald; Sawada, Stephen; Muller, David; Bondie, Diane; Hutchins, Gary; Schwaiger, Markus.

In: Journal of the American College of Cardiology, Vol. 26, No. 6, 15.11.1995, p. 1465-1475.

Research output: Contribution to journalArticle

@article{bd9852cac96b40139486405d5680d001,
title = "Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity",
abstract = "Objectives.: The aim of this study was to evaluate patients with coronary artery disease to 1) determine the relation between flow reserve measured by nitrogen-13 (N-13) ammonia kinetic modeling and stenosis severity assessed by quantitative angiography, and 2) examine whether flow reserve is impaired in regions supplied by vessels without significant angiographic disease. Background.: With the advent of new therapeutic approaches for coronary disease, an accurate noninvasive approach for absolute quantification of flow and flow reserve is needed to evaluate functional severity and extent of atherosclerosis. Nitrogen-13 ammonia kinetic modeling may permit such evaluation. Methods.: Twenty-seven subjects were classified into three groups: group 1 = 5 young volunteers; group 2 = 7 middle-aged volunteers; and group 3 = 15 patients with coronary artery disease. Dynamic N-13 ammonia positron emission tomographic imaging was performed at rest and during adenosine infusion. A three-compartment model was fit to regional N-13 ammonia kinetic data to determine myocardial flow. Group 3 patients underwent quantitative coronary angiography. Results.: The regional blood flow results in patients with coronary disease were classified into four subgroups: no significant detectable disease and mild (50{\%} to 69.9{\%} area stenosis), moderate (70{\%} to 94.9{\%} area stenosis) or severe (95{\%} to 100{\%} area stenosis) coronary disease. Flow reserve was 2.95 ± 0.65; 2.09 ± 0.47; 2.02 ± 0.51; 1.3 ± 0.32, respectively (p ≤ 0.01 except mild vs. moderate). Flow reserve was correlated with percent area stenosis (r = -0.56) and minimal lumen diameter (r = 0.75). In volunteers (groups 1 and 2), flow reserves were greater than in segments without detectable disease in group 3 patients (4.10 ± 0.71 and 3.79 ± 0.42, respectively, vs. 2.88 ± 0.56, p ≤ 0.02). Conclusions.: The functional severity of coronary disease measured by N-13 ammonia positron emission tomography varied for a given stenosis but was significantly related to angiographic severity. Among patients with coronary disease, myocardial regions without significant angiographic stenoses displayed reduced flow reserve than did regions in control subjects, indicating that vascular reactivity was more diffusely impaired in group 3 than was suggested by angiography. Noninvasive quantification of myocardial flow reserve using dynamic N-13 ammonia positron emission tomography yields important functional data that permit definition of the extent of disease even when disease is not apparent by angiography.",
author = "Beanlands, {Rob S B} and Otto Muzik and Pierre Melon and Ronald Sutor and Stephen Sawada and David Muller and Diane Bondie and Gary Hutchins and Markus Schwaiger",
year = "1995",
month = "11",
day = "15",
doi = "10.1016/0735-1097(95)00359-2",
language = "English (US)",
volume = "26",
pages = "1465--1475",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity

AU - Beanlands, Rob S B

AU - Muzik, Otto

AU - Melon, Pierre

AU - Sutor, Ronald

AU - Sawada, Stephen

AU - Muller, David

AU - Bondie, Diane

AU - Hutchins, Gary

AU - Schwaiger, Markus

PY - 1995/11/15

Y1 - 1995/11/15

N2 - Objectives.: The aim of this study was to evaluate patients with coronary artery disease to 1) determine the relation between flow reserve measured by nitrogen-13 (N-13) ammonia kinetic modeling and stenosis severity assessed by quantitative angiography, and 2) examine whether flow reserve is impaired in regions supplied by vessels without significant angiographic disease. Background.: With the advent of new therapeutic approaches for coronary disease, an accurate noninvasive approach for absolute quantification of flow and flow reserve is needed to evaluate functional severity and extent of atherosclerosis. Nitrogen-13 ammonia kinetic modeling may permit such evaluation. Methods.: Twenty-seven subjects were classified into three groups: group 1 = 5 young volunteers; group 2 = 7 middle-aged volunteers; and group 3 = 15 patients with coronary artery disease. Dynamic N-13 ammonia positron emission tomographic imaging was performed at rest and during adenosine infusion. A three-compartment model was fit to regional N-13 ammonia kinetic data to determine myocardial flow. Group 3 patients underwent quantitative coronary angiography. Results.: The regional blood flow results in patients with coronary disease were classified into four subgroups: no significant detectable disease and mild (50% to 69.9% area stenosis), moderate (70% to 94.9% area stenosis) or severe (95% to 100% area stenosis) coronary disease. Flow reserve was 2.95 ± 0.65; 2.09 ± 0.47; 2.02 ± 0.51; 1.3 ± 0.32, respectively (p ≤ 0.01 except mild vs. moderate). Flow reserve was correlated with percent area stenosis (r = -0.56) and minimal lumen diameter (r = 0.75). In volunteers (groups 1 and 2), flow reserves were greater than in segments without detectable disease in group 3 patients (4.10 ± 0.71 and 3.79 ± 0.42, respectively, vs. 2.88 ± 0.56, p ≤ 0.02). Conclusions.: The functional severity of coronary disease measured by N-13 ammonia positron emission tomography varied for a given stenosis but was significantly related to angiographic severity. Among patients with coronary disease, myocardial regions without significant angiographic stenoses displayed reduced flow reserve than did regions in control subjects, indicating that vascular reactivity was more diffusely impaired in group 3 than was suggested by angiography. Noninvasive quantification of myocardial flow reserve using dynamic N-13 ammonia positron emission tomography yields important functional data that permit definition of the extent of disease even when disease is not apparent by angiography.

AB - Objectives.: The aim of this study was to evaluate patients with coronary artery disease to 1) determine the relation between flow reserve measured by nitrogen-13 (N-13) ammonia kinetic modeling and stenosis severity assessed by quantitative angiography, and 2) examine whether flow reserve is impaired in regions supplied by vessels without significant angiographic disease. Background.: With the advent of new therapeutic approaches for coronary disease, an accurate noninvasive approach for absolute quantification of flow and flow reserve is needed to evaluate functional severity and extent of atherosclerosis. Nitrogen-13 ammonia kinetic modeling may permit such evaluation. Methods.: Twenty-seven subjects were classified into three groups: group 1 = 5 young volunteers; group 2 = 7 middle-aged volunteers; and group 3 = 15 patients with coronary artery disease. Dynamic N-13 ammonia positron emission tomographic imaging was performed at rest and during adenosine infusion. A three-compartment model was fit to regional N-13 ammonia kinetic data to determine myocardial flow. Group 3 patients underwent quantitative coronary angiography. Results.: The regional blood flow results in patients with coronary disease were classified into four subgroups: no significant detectable disease and mild (50% to 69.9% area stenosis), moderate (70% to 94.9% area stenosis) or severe (95% to 100% area stenosis) coronary disease. Flow reserve was 2.95 ± 0.65; 2.09 ± 0.47; 2.02 ± 0.51; 1.3 ± 0.32, respectively (p ≤ 0.01 except mild vs. moderate). Flow reserve was correlated with percent area stenosis (r = -0.56) and minimal lumen diameter (r = 0.75). In volunteers (groups 1 and 2), flow reserves were greater than in segments without detectable disease in group 3 patients (4.10 ± 0.71 and 3.79 ± 0.42, respectively, vs. 2.88 ± 0.56, p ≤ 0.02). Conclusions.: The functional severity of coronary disease measured by N-13 ammonia positron emission tomography varied for a given stenosis but was significantly related to angiographic severity. Among patients with coronary disease, myocardial regions without significant angiographic stenoses displayed reduced flow reserve than did regions in control subjects, indicating that vascular reactivity was more diffusely impaired in group 3 than was suggested by angiography. Noninvasive quantification of myocardial flow reserve using dynamic N-13 ammonia positron emission tomography yields important functional data that permit definition of the extent of disease even when disease is not apparent by angiography.

UR - http://www.scopus.com/inward/record.url?scp=0028800163&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028800163&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(95)00359-2

DO - 10.1016/0735-1097(95)00359-2

M3 - Article

C2 - 7594072

AN - SCOPUS:0028800163

VL - 26

SP - 1465

EP - 1475

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 6

ER -