Routine Clinical Quantitative Rest Stress Myocardial Perfusion for Managing Coronary Artery Disease Clinical Relevance of Test-Retest Variability
Routine Clinical Quantitative Rest Stress Myocardial Perfusion for Managing Coronary Artery Disease Clinical Relevance of Test-Retest Variability
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DOI：
10.1016/j.jcmg.2016.09.019
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发表时间：
2017-05-01
影响因子：
14
通讯作者：
Gould, K. Lance
中科院分区：
文献类型：
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作者：
Kitkungvan, Danai;Johnson, Nils P.;Gould, K. Lance
正电子发射断层扫描（PET）量化负荷心肌灌注（cc/min/g）和冠状动脉血流储备，以指导冠状动脉疾病的无创管理。本研究确定了他们的测试，再测试精度分钟内和每日生物变异性的基础上界定临床决策或低流量缺血阈值或后续changes.Background风险分层的基础上，血流储备分数引导经皮冠状动脉介入治疗的随机试验建立了一个客观的，定量的，结果驱动的生理狭窄严重程度的标准。然而，在这方面，方法对120名志愿者采用铷-82（Rb-82）进行连续708次PET灌注扫描，比较不同时间间隔内PET对同一患者静息-静息和负荷-负荷心肌灌注的时间进程和重复检测精度。和潘生丁压力的二维PET计算机断层扫描仪（GE DST 16）和德克萨斯大学HeartSee软件与我们验证的灌注模型。连续定量整体心肌灌注（间隔分钟）的（变异系数）为+/- 10%（静息时平均Delta SD +/- 0.09，应激时平均Delta SD +/- 0.23 cc/min/g），间隔天数为+/- 21%（静息时平均Delta SD +/- 0.2，应激时平均Delta SD +/- 0.46 cc/min/g），反映了增加的生物学变异性。全球心肌灌注在8分钟后，4分钟潘生丁输液是10%高于标准4分钟后潘生丁。结论：重复测试的方法精度的全球PET心肌灌注系列休息或应力PET分钟间隔为+/-10%。不同天之间的生物学加方法学变异性为+/-21%，从而建立生理严重程度的变异性边界，以指导或遵循冠状动脉疾病管理。最大应力增加灌注和冠状动脉血流储备，从而减少模拟缺血的潜在假低值。(C)2017年美国心脏病学院基金会。
OBJECTIVES Positron emission tomography (PET) quantifies stress myocardial perfusion (in cc/min/g) and coronary flow reserve to guide noninvasively the management of coronary artery disease. This study determined their test-retest precision within minutes and daily biological variability essential for bounding clinical decision-making or risk stratification based on low flow ischemic thresholds or follow-up changes.BACKGROUND Randomized trials of fractional flow reserve-guided percutaneous coronary interventions established an objective, quantitative, outcomes-driven standard of physiological stenosis severity. However, pressure-derived fractional flow reserve requires invasive coronary angiogram and was originally validated by comparison to noninvasive PET.METHODS The time course and test-retest precision of serial quantitative rest-rest and stress-stress global myocardial perfusion by PET within minutes and days apart in the same patient were compared in 120 volunteers undergoing serial 708 quantitative PET perfusion scans using rubidium 82 (Rb-82) and dipyridamole stress with a 2-dimensional PET-computed tomography scanner (GE DST 16) and University of Texas HeartSee software with our validated perfusion model.RESULTS Test-retest methodological precision (coefficient of variance) for serial quantitative global myocardial perfusion minutes apart is +/- 10% (mean Delta SD at rest +/- 0.09, at stress +/- 0.23 cc/min/g) and for days apart is +/- 21% (mean Delta SD at rest +/- 0.2, at stress +/- 0.46 cc/min/g) reflecting added biological variability. Global myocardial perfusion at 8 min after 4-min dipyridamole infusion is 10% higher than at standard 4 min after dipyridamole.CONCLUSIONS Test-retest methodological precision of global PET myocardial perfusion by serial rest or stress PET minutes apart is +/- 10%. Day-to-different-day biological plus methodological variability is +/- 21%, thereby establishing boundaries of variability on physiological severity to guide or follow coronary artery disease management. Maximum stress increases perfusion and coronary flow reserve, thereby reducing potentially falsely low values mimicking ischemia. (C) 2017 by the American College of Cardiology Foundation.