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PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease

The Journal of Biomedical Research 2013年第6期27卷 452-459页

作者： Bailing Hsu Nuclear Science and Engineering Institute University of Missouri-Columbia

Assessment of the relative distribution of myocardial flow with myocardial perfusion imaging （MPI） is meth- odologically limited to predict the presence or absence of flow-limited coronary artery disease （CAD）. This limi- tation may often occur, when obstructive lesions involve multiple epicardial coronary arteries or disease-related disturbances of the coronary circulation coexist at the microvascular level. Non-invasive assessment of myocar- dial blood flow in absolute units with position emission tomography （PET） has been positioned as the solution to improve CAD diagnosis and prediction of patient outcomes associated with risks for cardiac events. This article reviews technical and clinical aspects of myocardial blood flow quantitation with PET and discusses the practical consideration of this approach toward worldwide clinical utilization.

关键词： myocardial blood flow PET coronary artery disease

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Assessment of myocardial perfusion by positron emission tomography in patients with end-stage coronary artery disease treated with percutaneous myocardial revascularization

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Chinese Medical Journal 2009年第23期122卷 2807-2813页

作者： Marcus Wiemer Johannes Peter Wielepp Oliver Lindner Wolfgang Burchert Christoph Langer Dieter Horstkotte Thomas Butz Department of Cardiology Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum Bad Oeynhausen Germany Institute of Radiology Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia Ruhr University Bochum Bad Oeynhausen Germany

Background Reportedly, patients with persistent refractory angina due to end-stage coronary artery disease （CAD） not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization （TMR） or percutaneous myocardial revascularization （PMR）. In spite of several hypotheses （i.e., channel patency, placebo effect, denervation, neoangiogenesis）, the mechanism of action and the benefit remains controversial. Methods A prospective trial utilizing positron emission tomography （PET） was conducted as an attempt to correlate quantified myocardial blood flow （MBF） to clinical improvement following PMR. Thirteen consecutive patients with angina class 〉11 in spite of maximal medical treatment underwent PMR with a holmium：yttrium-aluminum-garnet （Ho：YAG） laser. MBF at rest and under hyperemia was assessed by [13N]ammonia PET at baseline, 3 and 6 months following PMR. Results Mean angina class and exercise tolerance time improved at 6 months compared with baseline （P 〈0.001）. The clinical results were accompanied with an improvement in hyperemic MBF （P=-0.05） and a reduction in minimal coronary resistance （MCR; P 〈0.05） in PMR-treated segments. Opposite effects, reduced hyperemic MBF and increased MCR, were observed in nontreated segments. The increase in MCR in nontreated segments revealed the favorable therapeutic impact achieved in PMR-treated segments. Conclusion The results of this trial utilizing a quantitative technique to quantify myocardial perfusion link clinical improvement post-PMR to neoangiogenesis and consistently improved microcirculation.

关键词： laser revascularization positron emission tomography myocardial blood flow

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Effects of Nitroglycerine on Erythrocyte Rheology:A Novel Mechanism to Explain the Enhancement of Nutrient blood flow to Ischemic Zones

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South China Journal of Cardiology 2007年第3期8卷 138-146页

作者： D.Elizabeth Le Sanjiv Kaul Cardiovascular Division Oregon Health and Science UniversityPortland

Objectives Nitroglycerine (NTG) enhances coronary blood flow to compromised myocardium is important in relieving ischemia. However, the mechanism for this increase in myocardial blood flow (MBF) is not well defined. In small vessels and capillaries, relative blood viscosity plays a very important role in determining myocardial vascular resistance (MVR). MVR reduce is due partly to the increase in negative charge of erythrocyte surface. We therefore hypothesized that the enhancement of nutrient blood flow to zones of myocardial ischemia during NTG is partly secondary to reduced MVR and blood flow viscosity. The latter is affected by the negative charge of erythrocyte surface. Methods 6 dogs with LAD flow-limiting stenosis (group 1) and 6 dogs with LAD flow-limiting stenosis and LCx occmusion (group 2) were studied. At baseline and during intracoronary infusions of NTG (0.3-0.6 μg·kg-1·min-1), hemodynamics, MBF (mL·min-1·g-1), whole blood viscosity (WBη, mPa. S), elongation index (EI), eletrophoretic mobility of erythocytes (EME, [μ.s-1)/(***-1)]) and percent wall thickening (%WT) were determined. MVR was calculated using driving pressure/MBF. Results As compared to baseline, no changes in hemodynamics were seen during NTG. MBF increased and MVR decreased significantly in normal bed, the central 25% and the entire of stenosed bed (Pmyocardial vascular resistance and blood viscosity due to the change of negative charge of erythrocyte

关键词： nitroglycerine myocardial blood flow myocardial vascular resistance whole blood viscosity erythrocyte rheology

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