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Quantitative assessment of myocardial blood flow using 13N-ammonium positron emission tomography in patients with coronary artery disease and intermediate coronary artery stenosis

Authors: Golukhova E.Z., Aslanidis I.P., Surkova N.A., Shurupova I.V., Trifonova T.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2026-20-2-244-256

For citation: Golukhova E.Z., Aslanidis I.P., Surkova N.A., Shurupova I.V., Trifonova T.A. Quantitative assessment of myocardial blood flow using 13N-ammonium positron emission tomography in patients with coronary artery disease and intermediate coronary artery stenosis. Creative Cardiology. 2026; 20 (2): 244–256 (in Russ.). DOI: 10.24022/1997-3187-2026-20-2-244-256

Received / Accepted:  13.04.2026 / 22.04.2026

Keywords: quantitative assessment of blood flow positron emission tomography with 13N-ammonium myocardial perfusion and microvascular dysfunction



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Abstract

Objective – to investigate the diagnostic capabilities of the visual and quantitative regional assessments during myocardial dynamic stress-PET/CT with 13N-ammonium in identification of multivessel (MV) coronary artery disease (CAD)

Material and methods. The study included 167 patients with IHD (72% men, 63.1±10.3 years), who underwent invasive coronary angiography (CAG) and stress-PET/CT with 13N-ammonium in dynamic mode. All patients had borderline coronary artery (CA) stenosis (40–70%), which amounted to 237 CA. The norm group consisted of 31 patients and 93 unchanged CA. Optimal border values (OBV) were determined for regional myocardial blood flow under load (regMKnarg), coronary reserve (regKR), and absolute blood flow difference (regARK.

Results. All 237 patients with PgS were divided into three groups: 1st group: patients with isolated PgS (IPgS, 134 patients), 2nd group: patients with occlusion or obstructive stenosis of another artery (OOPS, 66 patients), and 3rd group: patients with scars in regions adjacent to PgS (RPgS, 37 patients). A comparison of 3 groups of CA with PgS showed that blood flow and reserve in pools with PgS were significantly lower (p<0.001) if the patient had obstructive stenosis, occlusion, or scarring in nearby pools (the medians for Mcagr were 2.46; 2.19 and 2.09 ml/g/min, respectively). Blood flow in the intact CAS of patients with coronary heart disease (n=132) was lower (median 2.55 ml/g/min, p < 0.001) than in the CAS of healthy patients (median 2.88 ml/g/min, n=93). These observations are most likely related to the presence of CAD in patients with a greater obstructive burden on the coronary circ.ulation. The results of the ROC analysis showed a significant correlation between blood flow parameters and the presence of hemodynamically significant stenoses, which formed a group of 52 coronary arteries according to the following criteria: stenosis ≥90

Conclusion.  A comparison of 3 groups of coronary arteries with borderline stenoses allowed us to conclude that microvascular dysfunction has an effect on a decrease in regional myocardial blood flow under stress in intact coronary arteries and coronary arteries with borderline stenoses in patients with a large atherosclerotic "burden". The use of intact arteries in patients with coronary artery disease as "normal values" helped to take into account the effect of microvascular dysfunction when calculating optimal boundary values (myocardial blood flow at a load of <1.84 ml/g/min) for selecting hemodynamically significant boundary stenoses detected during coronary angiography and deciding on revascularization.

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About Authors

  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Director; ORCID
  • Irakliy P. Aslanidis, Dr. Med. Sci., Professor, Head of Department; ORCID
  • Natalia А. Surkova, Postgraduate; ORCID
  • Irina V. Shurupova, Dr. Med. Sci., Leading Research Associate, Radiologist; ORCID
  • Tatyana A. Trifonova, Cand. Med. Sci., Head of Department; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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