Long-Term Prognostic Value of 13N-Ammonia Myocardial Perfusion Positron Emission Tomography

Abstract

Perfusion findings in (13)N-ammonia PET and CFR are strong outcome predictors. CFR allows further risk stratification, suggesting a "warranty" period of 3 years if normal CFR is associated with normal perfusion. Conversely, in patients with abnormal perfusion, an impaired CFR has added value for predicting adverse outcomes.

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

“…However, the exact effects of hemodynamic change in multi-vessel disease on findings of MPI are yet to be completely known and should be studied in the future. The MBF heterogeneity might affect the regional MFR we investigated as concerned by some reports [10,28]. In this study the regional MFR was generally lower in pLAD stenosis throughout the LAD territory compared with mdLAD stenosis with two exceptions (segments 2 and 17), indicating its diagnostic implication in CAD.…”

“…Positron emission tomography (PET) with N-13 ammonia has several advantages, including absolute quantification of myocardial blood flow, repeated imaging with relatively less radiation exposure to patients and improved image quality compared with single photon emission computerized tomography (SPECT) [10][11][12]. In this study, we investigated the myocardial blood flow (MBF) and the image characteristics of the perfusion defects, for correct assignments of myocardial perfusion to coronary anatomy.…”

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

“…46,49,50,53,[92][93][94] Consistently, patients with more severely reduced stress MBF and MFR are at higher risk than patients with preserved values or modest reductions. An analysis of the relationship between MFR and cardiac mortality suggests an excellent prognosis for an MFR of more than 2 and a steady increase in cardiac mortality for an MFR of less than 2 ( Figure 8).…”

“…Stress-first or stress-only imaging is feasible, but it is not routine practice with quantitative PET. Although several studies have suggested that peak hyperemic MBF is superior to MFR, [45][46][47] most studies have concluded that MFR is more powerful for risk stratification, [48][49][50][51][52][53] perhaps because of decreased variability compared with peak hyperemic MBF. 54 Whether postischemic stunning affects resting MBF with stressfirst imaging has not been well studied.…”

Myocardial perfusion imaging in extreme obesity: Leveraging modern technologies to meet a modern challenge

“…CFR, calculated as the ratio of hyperemic to rest myocardial blood flow, provides a combined physiological measure of large-and small-vessel ischemia, and in the absence of overt CAD, is a marker of coronary microvascular dysfunction. CFR has emerged recently as an important prognostic indicator of cardiovascular risk, and identifies patients at risk for CVD death [18][19][20][21] independently of angiographic disease severity, 22,23 ischemic perfusion defects, LV ejection fraction, or a detectable troponin. 24 In particular, CFR may represent an important component of risk stratification in obesity, 25 which is increasingly recognized to be associated with global microvascular dysfunction.…”