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Myocardial perfusion reserve compared with peripheral perfusion reserve: a [13N]ammonia PET study

(2011) JOURNAL OF NUCLEAR CARDIOLOGY. 18(2). p.238-246
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Abstract
13N]ammonia PET allows quantification of myocardial perfusion. The similarity between peripheral flow and myocardial perfusion is unclear. We compared perfusion flow in the myocardium with the upper limb during rest and adenosine stress [13N]ammonia PET to establish whether peripheral perfusion reserve (PPR) correlates with MPR. [13N]ammonia myocardial perfusion PET-scans of 58 patients were evaluated (27 men, 31 women, age 64 +/- A 13 years) and were divided in four subgroups: patients with coronary artery disease (CAD, n = 15), cardiac syndrome X (SX, n = 14), idiopathic dilating cardiomyopathy (DCM, n = 16), and normal controls (NC, n = 13). Peripheral limb perfusion was measured in the muscular tissue of the proximal upper limb and quantified through a 2-tissue-compartment model and the PPR was calculated (stress/rest ratio). MPR was also calculated by a 2-tissue-compartment model. The PPR results were compared with the MPR findings. Mean myocardial perfusion increased significantly in all groups as evidenced by the MPR (CAD 1.99 +/- A 0.47; SX 1.39 +/- A 0.31; DCM 1.72 +/- A 0.69; NC 2.91 +/- A 0.78). Mean peripheral perfusion also increased but not significantly and accompanied with great variations within and between groups (mean PPR: CAD 1.30 +/- A 0.79; SX 1.36 +/- A 0.71; DCM 1.60 +/- A 1.22; NC 1.27 +/- A 0.63). The mean difference between PPR and MPR for all subpopulations varied widely. No significant correlations in flow reserve were found between peripheral and myocardial microcirculatory beds in any of the groups (Total group: r = -0.07, SEE = 0.70, CAD: r = 0.14, SEE = 0.48, SX: r = 0.17, SEE = 0.30, DCM: r = -0.11, SEE = 0.71, NC: r = -0.19, SEE = 0.80). No correlations between myocardial and peripheral perfusion (reserve) were found in different patient populations in the same PET session. This suggests a functional difference between peripheral and myocardial flow in the response to intravenously administered adenosine stress.
Keywords
ENDOTHELIAL FUNCTION, ADENOSINE, BLOOD-FLOW RESERVE, CORONARY-ARTERY-DISEASE, IDIOPATHIC DILATED CARDIOMYOPATHY, vasodilator stress N-13 ammonia, coronary flow reserve, Myocardial perfusion imaging, peripheral perfusion imaging, HEART, HETEROGENEITY, EXERCISE, HUMANS

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Chicago
Scholtens, AM, RA Tio, A Willemsen, Rudi Dierckx, HH Boersma, CJ Zeebregts, AWJM Glaudemans, and RHJA Slart. 2011. “Myocardial Perfusion Reserve Compared with Peripheral Perfusion Reserve: a [13N]ammonia PET Study.” Journal of Nuclear Cardiology 18 (2): 238–246.
APA
Scholtens, A., Tio, R., Willemsen, A., Dierckx, R., Boersma, H., Zeebregts, C., Glaudemans, A., et al. (2011). Myocardial perfusion reserve compared with peripheral perfusion reserve: a [13N]ammonia PET study. JOURNAL OF NUCLEAR CARDIOLOGY, 18(2), 238–246.
Vancouver
1.
Scholtens A, Tio R, Willemsen A, Dierckx R, Boersma H, Zeebregts C, et al. Myocardial perfusion reserve compared with peripheral perfusion reserve: a [13N]ammonia PET study. JOURNAL OF NUCLEAR CARDIOLOGY. 2011;18(2):238–46.
MLA
Scholtens, AM, RA Tio, A Willemsen, et al. “Myocardial Perfusion Reserve Compared with Peripheral Perfusion Reserve: a [13N]ammonia PET Study.” JOURNAL OF NUCLEAR CARDIOLOGY 18.2 (2011): 238–246. Print.
@article{1930953,
  abstract     = {13N]ammonia PET allows quantification of myocardial perfusion. The similarity between peripheral flow and myocardial perfusion is unclear. We compared perfusion flow in the myocardium with the upper limb during rest and adenosine stress [13N]ammonia PET to establish whether peripheral perfusion reserve (PPR) correlates with MPR. 
[13N]ammonia myocardial perfusion PET-scans of 58 patients were evaluated (27 men, 31 women, age 64 +/- A 13 years) and were divided in four subgroups: patients with coronary artery disease (CAD, n = 15), cardiac syndrome X (SX, n = 14), idiopathic dilating cardiomyopathy (DCM, n = 16), and normal controls (NC, n = 13). Peripheral limb perfusion was measured in the muscular tissue of the proximal upper limb and quantified through a 2-tissue-compartment model and the PPR was calculated (stress/rest ratio). MPR was also calculated by a 2-tissue-compartment model. The PPR results were compared with the MPR findings. 
Mean myocardial perfusion increased significantly in all groups as evidenced by the MPR (CAD 1.99 +/- A 0.47; SX 1.39 +/- A 0.31; DCM 1.72 +/- A 0.69; NC 2.91 +/- A 0.78). Mean peripheral perfusion also increased but not significantly and accompanied with great variations within and between groups (mean PPR: CAD 1.30 +/- A 0.79; SX 1.36 +/- A 0.71; DCM 1.60 +/- A 1.22; NC 1.27 +/- A 0.63). The mean difference between PPR and MPR for all subpopulations varied widely. No significant correlations in flow reserve were found between peripheral and myocardial microcirculatory beds in any of the groups (Total group: r = -0.07, SEE = 0.70, CAD: r = 0.14, SEE = 0.48, SX: r = 0.17, SEE = 0.30, DCM: r = -0.11, SEE = 0.71, NC: r = -0.19, SEE = 0.80). 
No correlations between myocardial and peripheral perfusion (reserve) were found in different patient populations in the same PET session. This suggests a functional difference between peripheral and myocardial flow in the response to intravenously administered adenosine stress.},
  author       = {Scholtens, AM and Tio, RA and Willemsen, A and Dierckx, Rudi and Boersma, HH and Zeebregts, CJ and Glaudemans, AWJM and Slart, RHJA},
  issn         = {1071-3581},
  journal      = {JOURNAL OF NUCLEAR CARDIOLOGY},
  keyword      = {ENDOTHELIAL FUNCTION,ADENOSINE,BLOOD-FLOW RESERVE,CORONARY-ARTERY-DISEASE,IDIOPATHIC DILATED CARDIOMYOPATHY,vasodilator stress N-13 ammonia,coronary flow reserve,Myocardial perfusion imaging,peripheral perfusion imaging,HEART,HETEROGENEITY,EXERCISE,HUMANS},
  language     = {eng},
  number       = {2},
  pages        = {238--246},
  title        = {Myocardial perfusion reserve compared with peripheral perfusion reserve: a [13N]ammonia PET study},
  url          = {http://dx.doi.org/10.1007/s12350-011-9339-2},
  volume       = {18},
  year         = {2011},
}

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