Document Detail


Impact of unexpected factors on quantitative myocardial perfusion and coronary flow reserve in young, asymptomatic volunteers.
MedLine Citation:
PMID:  21492816     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to quantify ranges of normal myocardial perfusion and flow reserve in young, asymptomatic volunteers after systematic historical and laboratory screening for unexpected factors affecting coronary flow.
BACKGROUND: Noninvasive cardiac positron emission tomography (PET) quantifies absolute flow and coronary flow reserve (CFR), thereby defining physiological severity of coronary artery disease for clinical studies or management. Defining "normal" coronary flow is a necessary prerequisite to its broad clinical application.
METHODS: Volunteers aged 20 to 40 years of age without cardiac disease or other conditions underwent rest-dipyridamole stress cardiac PET with absolute quantitative flow measurements using Rb-82 in paired studies at least 7 days apart for reproducibility. The presence of coronary calcium, detectable blood nicotine or caffeine, dyslipidemia, and an extended family history of early clinical atherosclerosis were objectively and systematically examined for grouping subjects as true normal or not normal.
RESULTS: We enrolled 125 volunteers, 107 (86%) underwent 2 PET scans. Fifty-six (45%) were classified as true normal, whereas 69 (55%) were classified as not normal. True normals had higher high-density lipoprotein and less PET scan heterogeneity. Hemodynamic responses to dipyridamole stress were similar. Rest flow was the same in both groups (0.72 ± 0.17 ml/min/g vs. 0.69 ± 0.14 ml/min/g, p = 0.164). However, stress flow (2.89 ± 0.50 ml/min/g vs. 2.63 ± 0.61 ml/min/g, p = 0.005) and CFR (4.17 ± 0.80 vs. 3.91 ± 0.86, p = 0.047) were higher in true normals. Paired studies were performed a median of 22 days (interquartile range: 15 to 39) apart. Reproducibility was improved in the true normal group.
CONCLUSIONS: One-half of young, asymptomatic volunteers from the community harbor unexpected factors that mildly but systematically reduce stress flow, CFR, and reproducibility. This study establishes normal ranges and reproducibility for flow and CFR as the basis for clinical applications.
Authors:
Stefano Sdringola; Nils P Johnson; Richard L Kirkeeide; Emma Cid; K Lance Gould
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  4     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-15     Completed Date:  2011-08-09     Revised Date:  2011-10-24    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  402-12     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, University of Texas Medical School, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Asymptomatic Diseases
Cardiovascular Diseases / diagnosis*,  etiology,  physiopathology
Chi-Square Distribution
Coronary Circulation*
Dipyridamole / diagnostic use
Female
Fractional Flow Reserve, Myocardial
Humans
Male
Myocardial Perfusion Imaging / methods*
Positron-Emission Tomography*
Predictive Value of Tests
Reference Values
Reproducibility of Results
Risk Assessment
Risk Factors
Rubidium Radioisotopes / diagnostic use
Vasodilator Agents / diagnostic use
Young Adult
Chemical
Reg. No./Substance:
0/Rubidium Radioisotopes; 0/Vasodilator Agents; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2011 Sep;4(9):999-1001   [PMID:  21920338 ]
JACC Cardiovasc Imaging. 2011 Apr;4(4):413-5   [PMID:  21492817 ]

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