Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients

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Circulation. 1989;79:825-835

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ARTICLES

Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients

LL Demer, KL Gould, RA Goldstein, RL Kirkeeide, NA Mullani, RW Smalling, A Nishikawa and ME Merhige
Department of Medicine, University of Texas Medical School, Houston 77225.

To assess the accuracy of positron emission tomography (PET) for evaluation of coronary artery disease (CAD), cardiac PET perfusion images were obtained at rest and with dipyridamole-handgrip stress in 193 patients undergoing coronary arteriography. PET images were reviewed by two independent readers blinded to clinical data. Subjective defect severity scores were assigned to each myocardial region on a 0 (normal) to 5 (severe) scale. Results were compared with arteriographic stenosis severity expressed as stenosis flow reserve (SFR), with continuous values ranging from 0 (total occlusion) to 5 (normal), calculated from quantitative arteriographic dimensions using automated detection of the vessel borders. There were 115 patients with significant CAD (SFR less than 3), 37 patients with mild CAD (3 less than or equal to SFR less than 4), and 41 patients with essentially normal coronaries (SFR greater than or equal to 4). With increasingly severe impairment of stenosis flow reserve, subjective PET defect severity increased. Despite wide scatter, a PET score of 2 or more was highly predictive of significant flow reserve impairment (SFR less than 3). For each patient, the score of the most severe PET defect correlated with the SFR of that patient's most severe stenosis (rs = 0.77 +/- 0.06). For each of 243 stenoses, PET defect score correlated with the SFR of the corresponding artery (rs = 0.63 +/- 0.08). PET defect location closely matched the region supplied by the diseased artery, and readers agreed whether the most severe PET defect was less than or more than 2 for 89% of patients.

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				K. L. Gould Not All Randomized Trials Are Equal J. Am. Coll. Cardiol., November 13, 2007; 50(20): 2013 - 2015. [Full Text] [PDF]

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				K. L. Gould, Y. Nakagawa, K. Nakagawa, S. Sdringola, M. J. Hess, M. Haynie, N. Parker, N. Mullani, and R. Kirkeeide Frequency and Clinical Implications of Fluid Dynamically Significant Diffuse Coronary Artery Disease Manifest as Graded, Longitudinal, Base-to-Apex Myocardial Perfusion Abnormalities by Noninvasive Positron Emission Tomography Circulation, April 25, 2000; 101(16): 1931 - 1939. [Abstract] [Full Text] [PDF]

				N. Al-Saadi, E. Nagel, M. Gross, A. Bornstedt, B. Schnackenburg, C. Klein, W. Klimek, H. Oswald, and E. Fleck Noninvasive Detection of Myocardial Ischemia From Perfusion Reserve Based on Cardiovascular Magnetic Resonance Circulation, March 28, 2000; 101(12): 1379 - 1383. [Abstract] [Full Text] [PDF]

				T. D. Ruddy, R. A. deKemp, and R. S. Beanlands Taking PET to heart Can. Med. Assoc. J., November 1, 1999; 161(9): 1131 - 1131. [Full Text] [PDF]

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				C. Caiati, N. Zedda, C. Montaldo, R. Montisci, and S. Iliceto Contrast-enhanced transthoracic second harmonic echo doppler with adenosine: A noninvasive, rapid and effective method for coronary flow reserve assessment J. Am. Coll. Cardiol., July 1, 1999; 34(1): 122 - 130. [Abstract] [Full Text] [PDF]

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