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- Danad, Ibrahim, et al.
(författare)
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Quantitative Assessment of Myocardial Perfusion in the Detection of Significant Coronary Artery Disease Cutoff Values and Diagnostic Accuracy of Quantitative [O-15]H2O PET Imaging
- 2014
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 64:14, s. 1464-1475
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Recent studies have demonstrated improved diagnostic accuracy for detecting coronary artery disease (CAD) when myocardial blood flow (MBF) is quantified in absolute terms, but there are no uniformly accepted cutoff values for hemodynamically significant CAD. OBJECTIVES The goal of this study was to determine cutoff values for absolute MBF and to evaluate the diagnostic accuracy of quantitative [O-15]H2O positron emission tomography (PET). METHODS A total of 330 patients underwent both quantitative [O-15]H2O PET imaging and invasive coronary angiography in conjunction with fractional flow reserve measurements. A stenosis >90% and/or fractional flow reserve <= 0.80 was considered obstructive; a stenosis <30% and/or fractional flow reserve >0.80 was nonobstructive. RESULTS Hemodynamically significant CAD was diagnosed in 116 (41%) of 281 patients who fulfilled study criteria for CAD. Resting perfusion was 1.00 +/- 0.25 and 0.92 +/- 0.23 ml/min/g in regions supplied by nonstenotic and significantly stenosed vessels, respectively (p < 0.001). During stress, perfusion increased to 3.26 +/- 1.04 ml/min/g and 1.73 +/- 0.67 ml/min/g, respectively (p < 0.001). The optimal cutoff values were 2.3 and 2.5 for hyperemic MBF and myocardial flow reserve, respectively. For MBF, these cutoff values showed a sensitivity, specificity, and accuracy for detecting significant CAD of 89%, 84%, and 86%, respectively, at a per-patient level and 87%, 85%, and 85% at a per-vessel level. The corresponding myocardial flow reserve values were 86%, 72%, and 78% (per patient) and 80%, 82%, and 81% (per vessel). Age and sex significantly affected diagnostic accuracy of quantitative PET. CONCLUSIONS Quantitative MBF measurements with the use of [O-15]H2O PET provided high diagnostic performance, but both sex and age should be taken into account.
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- Laaksonen, Marko, 1975-, et al.
(författare)
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Perfusion heterogeneity does not explain excess muscle oxygen uptake during variable intensity exercise
- 2010
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 30:4, s. 241-249
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Tidskriftsartikel (refereegranskat)abstract
- The association between muscle oxygen uptake (VO2) and perfusion or perfusion heterogeneity (relative dispersion, RD) was studied in eight healthy male subjects during intermittent isometric (1 s on, 2 s off) one-legged knee-extension exercise at variable intensities using positron emission tomography and a-v blood sampling. Resistance during the first 6 min of exercise was 50% of maximal isometric voluntary contraction force (MVC) (HI-1), followed by 6 min at 10% MVC (LOW) and finishing with 6 min at 50% MVC (HI-2). Muscle perfusion and O2 delivery during HI-1 (26 ± 5 and 5·4 ± 1·0 ml 100 g−1 min−1) and HI-2 (28 ± 4 and 5·8 ± 0·7 ml 100 g−1 min−1) were similar, but both were higher (P<0·01) than during LOW (15 ± 3 and 3·0 ± 0·6 ml 100 g−1 min−1). Muscle VO2 was also higher during both HI workloads (HI-1 3·3 ± 0·4 and HI-2 4·1 ± 0·6 ml 100 g−1 min−1) than LOW (1·4 ± 0·4 ml 100 g−1 min−1; P<0·01) and 25% higher during HI-2 than HI-1 (P<0·05). O2 extraction was higher during HI workloads (HI-1 62 ± 7 and HI-2 70 ± 7%) than LOW (45 ± 8%; P<0·01). O2 extraction tended to be higher (P = 0·08) during HI-2 when compared to HI-1. Perfusion was less heterogeneous (P<0·05) during HI workloads when compared to LOW with no difference between HI workloads. Thus, during one-legged knee-extension exercise at variable intensities, skeletal muscle perfusion and O2 delivery are unchanged between high-intensity workloads, whereas muscle VO2 is increased during the second high-intensity workload. Perfusion heterogeneity cannot explain this discrepancy between O2 delivery and uptake. We propose that the excess muscle VO2 during the second high-intensity workload is derived from working muscle cells.
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- Laaksonen, Marko S, 1975-, et al.
(författare)
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VO2peak, myocardial hypertrophy, and myocardial blood flow in endurance-trained men
- 2014
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Ingår i: Medicine and science in sports and exercise. - 1530-0315. ; 46:8, s. 1498-1505
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Endurance training induces cardiovascular and metabolic adaptations, leading to enhanced endurance capacity and exercise performance. Previous human studies have shown contradictory results in functional myocardial vascular adaptations to exercise training, and we hypothesized that this may be related to different degrees of hypertrophy in the trained heart. METHODS: We studied the interrelationships between peak aerobic power (V̇O2peak), myocardial blood flow (MBF) at rest and during adenosine-induced vasodilation, and parameters of myocardial hypertrophy in endurance-trained (ET, n = 31) and untrained (n = 17) subjects. MBF and myocardial hypertrophy were studied using positron emission tomography and echocardiography, respectively. RESULTS: Both V̇O2peak (P < 0.001) and left ventricular (LV) mass index (P < 0.001) were higher in the ET group. Basal MBF was similar between the groups. MBF during adenosine was significantly lower in the ET group (2.88 ± 1.01 vs 3.64 ± 1.11 mLg-1min-1, P < 0.05) but not when the difference in LV mass was taken into account. V̇O2peak correlated negatively with adenosine-stimulated MBF, but when LV mass was taken into account as a partial correlate, this correlation disappeared. CONCLUSIONS: The present results show that increased LV mass in ET subjects explains the reduced hyperemic myocardial perfusion in this subject population and suggests that excessive LV hypertrophy has negative effect on cardiac blood flow capacity.
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