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Jørgen Frøkiær

Quantitative perfusion parameters in a cohort of patients with no known ischemic heart disease and normal myocardial perfusion imaging studied by 82Rb-PET

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Purpose
82Rb perfusion PET allows for visual as well as quantitative interpretation of myocardial function. Whereas visual interpretation relies on intra-individual redistribution of the tracer between rest and stress studies, quantitative interpretation of absolute flow values requires robust knowledge of reference values in the patient population. Only few studies have reported normal ranges of myocardial perfusion obtained by 82Rb PET and it was therefore our goal to establish these values.
Methods
Three hundred and thirty patients with chest pain or dyspnea examined by 82Rb-PET during a 6-month period were screened for eligibility. One hundred and eighty patients with no prior history of ischemic heart disease, a normal MPI scan defined by visual interpretation and no coronary events for a follow-up period of 6 months were included as normal. Quantitative parameters were calculated using commercially available software (QPET, Cedars Sinai). Parameters included were regional and global rest and stress myocardial blood flow (MBF) values, ejection fraction (EF) and total perfusion deficit (TPD).
Results
Mean global MBF at stress was 2.92 mL/g/min (±SD 0.49), lower limit (LL) 1.94 mL/g/min. Regional mean MBF at the apex was 2.83 mL/g/min (±SD 0.61), LL 1.61 mL/g/min, inferior wall 2.96 mL/g/min (±SD 0.56), LL 1.84 mL/g/min, lateral wall 3.10 mL/g/min (±SD 0.62), LL 1.86 mL/g/min, anterior wall 2.83 mL/g/min (±SD 0.53), LL 1.77 mL/g/min and septal wall 2.88 mL/g/min (±SD 0.51 mL/g/min), LL 1.86 mL/g/min. Global coronary flow reserve (CFR) was 2.81 (±SD 0.71). EF at rest was 65.3% (±SD 10) and during stress 69% (±SD 12.3), yielding an EF reserve of 4.5%. TPD at rest and stress was 6% (±SD 4).
Conclusion
Based on a representative population of patients in which coronary artery disease was ruled out, we propose the following lower cut-off points for MBF normal range (mL/g/min): global 2, apex 1.6, septum 1.8, anterior wall 1.8, lateral wall 1.8 and inferior wall 1.8. CFR had a wide range reflecting large variability in resting flow rates indicating that CFR should be interpreted with caution. In line with this, TPD calculated from software provided normal material also generated a too variable parameter to be used in a clinical setting.
Original languageEnglish
Publication year4 May 2015
Publication statusPublished - 4 May 2015
EventInternational Conference of Nuclear Cardiology and Cardiac CT - Madrid, Spain
Duration: 3 May 20155 May 2015

Conference

ConferenceInternational Conference of Nuclear Cardiology and Cardiac CT
CountrySpain
CityMadrid
Period03/05/201505/05/2015

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