UNLABELLED: Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. METHODS: We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. RESULTS: Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). CONCLUSION: A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.
UNLABELLED: Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. METHODS: We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. RESULTS: Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). CONCLUSION: A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.
Authors: K L Gould; Y Nakagawa; K Nakagawa; S Sdringola; M J Hess; M Haynie; N Parker; N Mullani; R Kirkeeide Journal: Circulation Date: 2000-04-25 Impact factor: 29.690
Authors: M L Ladenheim; B H Pollock; A Rozanski; D S Berman; H M Staniloff; J S Forrester; G A Diamond Journal: J Am Coll Cardiol Date: 1986-03 Impact factor: 24.094
Authors: D B Pryor; L Shaw; C B McCants; K L Lee; D B Mark; F E Harrell; L H Muhlbaier; R M Califf Journal: Ann Intern Med Date: 1993-01-15 Impact factor: 25.391
Authors: Julio A Panza; Thomas A Holly; Federico M Asch; Lilin She; Patricia A Pellikka; Eric J Velazquez; Kerry L Lee; Salvador Borges-Neto; Pedro S Farsky; Robert H Jones; Daniel S Berman; Robert O Bonow Journal: J Am Coll Cardiol Date: 2013-03-07 Impact factor: 24.094
Authors: R Parkash; R A deKemp; T D Ruddy; A Kitsikis; R Hart; L Beauchesne; L Beauschene; Kathryn Williams; R A Davies; M Labinaz; R S B Beanlands Journal: J Nucl Cardiol Date: 2004 Jul-Aug Impact factor: 5.952
Authors: Jonathan B Moody; Benjamin C Lee; James R Corbett; Edward P Ficaro; Venkatesh L Murthy Journal: J Nucl Cardiol Date: 2015-04-14 Impact factor: 5.952
Authors: Ankur Gupta; Viviany R Taqueti; Tim P van de Hoef; Navkaranbir S Bajaj; Paco E Bravo; Venkatesh L Murthy; Michael T Osborne; Sara B Seidelmann; Tomas Vita; Courtney F Bibbo; Meagan Harrington; Jon Hainer; Ornella Rimoldi; Sharmila Dorbala; Deepak L Bhatt; Ron Blankstein; Paolo G Camici; Marcelo F Di Carli Journal: Circulation Date: 2017-09-01 Impact factor: 29.690