Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis?
Positron emission tomography/computed tomography (PET/CT) applied with positron-emitting flow tracers such as 13N-ammonia and 82Rubidium enables the quantification of both myocardial perfusion and myocardial blood flow (MBF) in milliliters per gram per minute for coronary artery disease (CAD) detect...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fcvm.2017.00046/full |
| _version_ | 1819062696036794368 |
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| author | Thorsten M. Leucker Ines Valenta Thomas Hellmut Schindler Thomas Hellmut Schindler |
| author_facet | Thorsten M. Leucker Ines Valenta Thomas Hellmut Schindler Thomas Hellmut Schindler |
| author_sort | Thorsten M. Leucker |
| collection | DOAJ |
| description | Positron emission tomography/computed tomography (PET/CT) applied with positron-emitting flow tracers such as 13N-ammonia and 82Rubidium enables the quantification of both myocardial perfusion and myocardial blood flow (MBF) in milliliters per gram per minute for coronary artery disease (CAD) detection and characterization. The detection of a regional myocardial perfusion defect during vasomotor stress commonly identifies the culprit lesion or most severe epicardial narrowing, whereas adding regional hyperemic MBFs, myocardial flow reserve (MFR), and/or longitudinal flow decrease may also signify less severe but flow-limiting stenosis in multivessel CAD. The addition of regional hyperemic flow parameters, therefore, may afford a comprehensive identification and characterization of flow-limiting effects of multivessel CAD. The non-specific origin of decreases in hyperemic MBFs and MFR, however, prompts an evaluation and interpretation of regional flow in the appropriate context with the presence of obstructive CAD. Conversely, initial results of the assessment of a longitudinal hyperemic flow gradient suggest this novel flow parameter to be specifically related to increases in CAD caused epicardial resistance. The concurrent assessment of myocardial perfusion and several hyperemic flow parameters with PET/CT may indeed open novel avenues of precision medicine to guide coronary revascularization procedures that may potentially lead to a further improvement in cardiovascular outcomes in CAD patients. |
| first_indexed | 2024-12-21T15:02:53Z |
| format | Article |
| id | doaj.art-c5e798119830477c8bf632ddf2c58cf3 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-21T15:02:53Z |
| publishDate | 2017-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-c5e798119830477c8bf632ddf2c58cf32022-12-21T18:59:33ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2017-07-01410.3389/fcvm.2017.00046268633Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis?Thorsten M. Leucker0Ines Valenta1Thomas Hellmut Schindler2Thomas Hellmut Schindler3Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment of Radiology, School of Medicine, Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDepartment of Radiology, School of Medicine, Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesPositron emission tomography/computed tomography (PET/CT) applied with positron-emitting flow tracers such as 13N-ammonia and 82Rubidium enables the quantification of both myocardial perfusion and myocardial blood flow (MBF) in milliliters per gram per minute for coronary artery disease (CAD) detection and characterization. The detection of a regional myocardial perfusion defect during vasomotor stress commonly identifies the culprit lesion or most severe epicardial narrowing, whereas adding regional hyperemic MBFs, myocardial flow reserve (MFR), and/or longitudinal flow decrease may also signify less severe but flow-limiting stenosis in multivessel CAD. The addition of regional hyperemic flow parameters, therefore, may afford a comprehensive identification and characterization of flow-limiting effects of multivessel CAD. The non-specific origin of decreases in hyperemic MBFs and MFR, however, prompts an evaluation and interpretation of regional flow in the appropriate context with the presence of obstructive CAD. Conversely, initial results of the assessment of a longitudinal hyperemic flow gradient suggest this novel flow parameter to be specifically related to increases in CAD caused epicardial resistance. The concurrent assessment of myocardial perfusion and several hyperemic flow parameters with PET/CT may indeed open novel avenues of precision medicine to guide coronary revascularization procedures that may potentially lead to a further improvement in cardiovascular outcomes in CAD patients.http://journal.frontiersin.org/article/10.3389/fcvm.2017.00046/fullCADmyocardial ischemiamyocardial blood flowmyocardial flow reservemultivessel diseasepositron emission tomography |
| spellingShingle | Thorsten M. Leucker Ines Valenta Thomas Hellmut Schindler Thomas Hellmut Schindler Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? Frontiers in Cardiovascular Medicine CAD myocardial ischemia myocardial blood flow myocardial flow reserve multivessel disease positron emission tomography |
| title | Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? |
| title_full | Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? |
| title_fullStr | Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? |
| title_full_unstemmed | Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? |
| title_short | Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis? |
| title_sort | positron emission tomography determined hyperemic flow myocardial flow reserve and flow gradient quo vadis |
| topic | CAD myocardial ischemia myocardial blood flow myocardial flow reserve multivessel disease positron emission tomography |
| url | http://journal.frontiersin.org/article/10.3389/fcvm.2017.00046/full |
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