DIagnostic performance of quantitative13N-ammonia positron emission tomographycombined with computed tomography measuresof myocardial blood flow and coronary flowreserve for the assessment of functionalsignificance of coronary stenoses

Authors: Bockeria L.A., Aslanidis I.P., Shavman M.G., Shurupova I.V., Trifonova T.A., Ekaeva I.V.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2019-13-1-17-27

For citation: Bockeria L.A., Aslanidis I.P., Shavman M.G., Shurupova I.V., Trifonova T.A., Ekaeva I.V. Diagnostic performance of quantitative 13N-ammonia positron emission tomography combined with computed tomography measures of myocardial blood flow and coronary flow reserve for the assessment of functional significance of coronary stenoses. Creative Cardiology. 2019; 13 (1): 17–27 (in Russ.). DOI: 10.24022/1997-3187-2019-13-1-17-27

Received / Accepted:  19.02.2019/22.02.2019

Keywords: myocardial blood flow coronary flow reserve positron emission tomography computed tomography 13N-ammonia

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Abstract

Objective. The goal of this study was to determine the optimal cutoff values for stress myocardial blood flow (MBF) and coronary flow reserve (CFR) derived by 13N-ammonia positron emission tomography combined with computed tomography (PET/CT) for the detection of coronary stenoses 50% and more and to evaluate the diagnostic performance of the method in patients with suspected coronary artery disease (CAD).

Material and methods. 81 patients underwent dynamic stress-PET/CT and invasive coronary angiography; the absolute values of MBF and CFR were calculated.

Results. We analyzed 243 coronary arteries (CA), including 137 with significant (50% and more) stenosis by invasive coronary angiography. Using the ROC-analysis optimal cutoff value for the detection of coronary stenoses 50% and more for stress MBF was 2.09 and less ml/min/g and for CFR was 2.50 and less with a very good model quality: for MBF the area-under-the-ROC curve (AUC) 0.86, p<0.001 and for CFR AUC 0.89, p<0.001. Using the obtained cutoff values, the diagnostic performance of PET/CT for the detection of CAD were assessed: sensitivity, specificity and diagnostic accuracy for regional and segmental CFR were 84, 92, 85% and 88, 69, 85% respectively; for MBF – 85, 69, 83% and 84, 61, 80% respectively.

Conclusion. The optimal cutoff values for the detection of significant coronary stenoses are CFR 2.50 and less and stress MBF 2.09 ml/min/g and less. Dynamic PET/CT showed a high accuracy in the detection of CAD. Detection of obstructive lesion of a single artery is characterized by high sensitivity and lower specificity. These results might be determined by the decrease of CFR due to not only by obstructive CA lesions, but also by endothelial dysfunction.

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About Authors

  • Leo A. Bockeria, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, Director, orcid.org/0000-0002-6180-2619;
  • Irakliy P. Aslanidis, Dr Med. Sc., Professor, Head of Department, ORCID;
  • Margarita G. Shavman, Junior Researcher, Radiologist, ORCID;
  • Irina V. Shurupova, Dr Med. Sc., Senior Researcher, Radiologist, ORCID;
  • Tat’yana A. Trifonova, Cand. Med. Sc., Head of Department, ORCID;
  • Irina V. Ekaeva, Cand. Chem. Sc., Leading Researcher, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery