Relationships between left ventricular asynchrony and myocardial blood flow
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82Rb PET protocols enable determination of left ventricular asynchrony (LVAS) at rest and stress, along with myocardial blood flow (MBF). We hypothesized that in patients with resting LVAS, MBF differs between those with stress-induced LVAS improvement and those with stress-induced LVAS deterioration.
We retrospectively analyzed 82Rb rest/regadenoson stress PET studies of 195 patients evaluated for known or suspected coronary artery disease. MBF was computed from first-pass data; function and relative perfusion were computed from myocardial equilibrium data. LVAS was defined as phase contraction bandwidth (BW) above 82Rb gender-specific normal limits, with changes defined as BW moving into or out of normal ranges.
Among the 195 patients, 64 had LVAS at rest, of whom 13 reverted to normal and 51 continued to have LVAS with stress. Patients who did not improve had lower stress MBF (1.04 ± 0.69 vs 1.58 ± 0.67, p = .02) and coronary flow reserve (1.94 ± 1.16 vs 3.04 ± 1.22, p = .01) than those who did improve. ROC analysis indicated that the parameter most strongly associated with improvement in asynchrony for patients with resting LVAS was reduction in MBF heterogeneity (ROC area (accuracy) = 84%, sensitivity = 92%, and specificity = 67%).
LVAS is highly correlated with MBF and CVR, with stress-induced improvement in synchronicity most strongly associated with improved MBF homogeneity.
KeywordsPET/CT asynchrony coronary flow reserve rubidium isotopes
Coronary flow reserve
Cardiac resynchronization therapy
Coronary vascular resistance
Left ventricular asynchrony
Myocardial blood flow
Ordered subset expectation maximization
Co-authors John R. Votaw, C. David Cooke, and Kenneth J. Nichols participate in royalties from Syntermed, Inc., in relation to some of the algorithms discussed in this manuscript. This work was supported in part by a Grant from NIH, R01HL085417-04.
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