High Prevalence of Myocardial Perfusion Abnormalities on Positron Emission Tomography in Asymptomatic Persons With a Parent or Sibling With Coronary Artery Disease

Abstract

Background-We hypothesized that asymptomatic persons with a parent or sibling with coronary artery disease (CAD) have myocardial perfusion defects on positron emission tomography (PET) as markers of early CAD. Methods and Results-After medical and family histories were recorded, 90 subjects underwent rest-dipyridamole cardiac PET perfusion imaging, including 18 index cases (a subject with CAD documented by PET and arteriography), 32 asymptomatic adults without known CAD who had a parent or sibling with CAD among these index cases, 30 asymptomatic subjects with comparable coronary risk factors without CAD or a family history of CAD, and 10 volunteer control subjects with no risk factors and no family history. PET perfusion images were quantified with automated software for size of abnormalities as percent of the cardiac image outside 95% CIs of normal controls and for severity as the lowest quadrant average relative activity. Of asymptomatic subjects with a parent or sibling with CAD (first-degree relatives), 50% had dipyridamole-induced myocardial perfusion defects that involved Ն5% of the cardiac image outside normal 95% CIs with or without other risk factors. The size of perfusion defects was larger in first-degree relatives than in control subjects (11Ϯ13% versus 1Ϯ1%, Pϭ0.02) and larger than in asymptomatic subjects with comparable risk factors but no family history of CAD (11Ϯ13% versus 5Ϯ6%, Pϭ0.02). Conclusions-This

Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population

“…Other screening approaches are becoming more available and potentially may have a role in screening of high-risk families. 28 -30 Sdringola et al 30 documented the presence of significant dipyridamole-induced perfusion abnormalities on PET in half of asymptomatic adults with a parent or sibling with CAD.…”

Structural epicardial disease and microvascular function are determinants of an abnormal longitudinal myocardial blood flow difference in cardiovascular risk individuals as determined with PET/CT

“…1,2,5,6 Conversely, functional and/or structural abnormalities of the coronary arterial wall may impair flow-mediated coronary vasodilation predominantly of the epicardial artery. [7][8][9][10] Such functional alterations or diffuse epicardial narrowing of the epicardial arteries, 7,9,11 commonly accompanied by an impairment of flow-mediated vasodilation, have been suggested as cause for a more recently described longitudinal decrease in myocardial perfusion or MBF during pharmacologically stimulated hyperemia. [7][8][9] Until recently, PET flow studies assessing the longitudinal base-to-apex MBF gradient during pharmacologic vasodilation did not provide information on the presence of structural coronary artery disease (CAD).…”

“…[7][8][9][10] Such functional alterations or diffuse epicardial narrowing of the epicardial arteries, 7,9,11 commonly accompanied by an impairment of flow-mediated vasodilation, have been suggested as cause for a more recently described longitudinal decrease in myocardial perfusion or MBF during pharmacologically stimulated hyperemia. [7][8][9] Until recently, PET flow studies assessing the longitudinal base-to-apex MBF gradient during pharmacologic vasodilation did not provide information on the presence of structural coronary artery disease (CAD). Thus, it remains uncertain how the presence or absence of structural alterations of the epicardial artery may affect the manifestation of an abnormal longitudinal, base-to-apex MBF gradient during higher coronary flows.…”

Effect of Outflow Tract Contributions to 82Rb-PET Global Myocardial Blood Flow Computations

“…Reproducibility of MBF measurements has been studied for several different algorithms (7), and sources of variability have been explored, including unexpected decreases in MBF, MFR, and measurement reproducibility for supposedly healthy subjects (8,9). Questions have arisen as to whether the apparently wide variability in PET measurements for healthy subjects is due to variations associated with age and sex or to technical factors that augment imprecision (10,11).…”