| Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. | |
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MedLine Citation:
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PMID: 19520347 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study tests the hypothesis that absolute measurement of adenosine (Ado)-stimulated myocardial blood flow (MBFado) is superior to measurement of relative tracer uptake for identification of hemodynamically significant coronary artery disease (CAD). BACKGROUND: Positron emission tomography measurement of absolute myocardial blood flow (MBF) ((13)N-ammonia) with Ado has the capability to more accurately assess hemodynamic severity of CAD than measurement of relative tracer content (TC) (nCi/ml) during Ado, which by definition depends on at least 1 normal zone to which others are compared. METHODS: A total of 27 patients (20 male, 58 +/- 11 years, mean +/- SD) with known or suspected CAD and 21 normal subjects (13 male, 38 +/- 10 years) were studied. Parametric (K1) MBF images and TC sum images were analyzed. A stenosis > or =70% defined significant CAD. The receiver-operator characteristic curve (ROC) analysis area under the curve (AUC) compared MBF and TC results. Cut-point analysis for sensitivity, specificity, and accuracy showed the best MBF criteria for CAD as MBFado <1.85 ml/min/g and the best TC as <70% maximum. The myocardial blood flow reserve ratio (MBFR) (optimal <2.0x) also was studied. RESULTS: The ROC analysis of PET parameters showed that MBFado was superior to <70% maximum uptake for CAD detection (n = 144 vessels; AUC 0.900 vs. 0.690, respectively, p < 0.0001) and was marginally greater than MBFR (0.856; p = 0.10). For CAD cut-point analysis, MBFado accuracy exceeded TC (0.84 vs. 0.72, respectively, p = 0.005), as did sensitivity (0.81 vs. 0.48, respectively; p = 0.001). Specificity of MBFado for CAD classification (0.85) was comparable to TC (0.82; p = NS). Sensitivity, specificity, and predictive accuracy for MBFR were 0.62, 0.85, and 0.79, respectively. The difference in specificity was not significant versus MBFado. However, MBFado was more sensitive than MBFR (p = 0.01). The difference in predictive accuracy was borderline (p = 0.06) in favor of MBFado. CONCLUSIONS: Measurement of Ado-stimulated absolute MBF is superior to relative measurement of myocardial tracer retention for identification of CAD and can be accomplished with a single MBFado measurement. |
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Authors:
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Mohammad M Hajjiri; Marcia B Leavitt; Hui Zheng; Amy E Spooner; Alan J Fischman; Henry Gewirtz |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JACC. Cardiovascular imaging Volume: 2 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-06-12 Completed Date: 2009-09-01 Revised Date: 2011-10-24 |
Medline Journal Info:
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Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
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Languages: eng Pagination: 751-8 Citation Subset: IM |
Affiliation:
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Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
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pharmacology* Adult Ammonia* Coronary Angiography Coronary Artery Disease / radionuclide imaging Coronary Circulation / drug effects* Coronary Stenosis / radiography, radionuclide imaging* Female Humans Male Middle Aged Nitrogen Radioisotopes / diagnostic use* Positron-Emission Tomography* ROC Curve Radiopharmaceuticals / diagnostic use* Vasodilator Agents / pharmacology* |
| Chemical | |
Reg. No./Substance:
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0/Nitrogen Radioisotopes; 0/Radiopharmaceuticals; 0/Vasodilator Agents; 58-61-7/Adenosine; 7664-41-7/Ammonia |
| Comments/Corrections | |
Comment In:
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JACC Cardiovasc Imaging. 2011 Sep;4(9):999-1001
[PMID:
21920338
]
JACC Cardiovasc Imaging. 2009 Jun;2(6):759-60 [PMID: 19520348 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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