Impact of Unexpected Factors on Quantitative Myocardial Perfusion and Coronary Flow Reserve in Young, Asymptomatic Volunteers
Impact of Unexpected Factors on Quantitative Myocardial Perfusion and Coronary Flow Reserve in Young, Asymptomatic Volunteers
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DOI：
10.1016/j.jcmg.2011.02.008
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发表时间：
2011-04-01
影响因子：
14
通讯作者：
Gould, K. Lance
中科院分区：
文献类型：
--
作者：
Sdringola, Stefano;Johnson, Nils P.;Gould, K. Lance
目的在对影响冠状动脉血流的意外因素进行系统的历史和实验室筛选后，我们试图量化年轻、无症状志愿者的正常心肌血流灌注和血流储备的范围。背景：无创心脏正电子发射断层扫描(PET)可以量化绝对血流和冠状动脉血流储备(CFR)，从而为临床研究或治疗确定冠状动脉疾病的生理严重程度。定义“正常”冠脉血流是其广泛临床应用的必要前提。方法年龄在20-40岁，无心脏病或其他疾病的志愿者接受静息-双嘧达莫负荷心脏PET，在配对研究中使用RB-82绝对定量血流测量，为了重复性，至少相隔7天。对冠脉钙化的存在、可检测到的血液尼古丁或咖啡因、血脂异常和早期临床动脉粥样硬化的家族史进行了客观和系统的检查，将受试者分为正常和不正常两组。结果我们招募了125名志愿者，107名(86%)接受了2次PET扫描。56人(45%)被归类为真正正常，而69人(55%)被归类为不正常。真正的正常人具有较高的高密度脂蛋白和较低的PET扫描异质性。对潘生丁应激的血流动力学反应相似。两组静息流量相同(0.72±0.17ml/min/g vs.0.69±0.14ml/min/g，p=0.164)。然而，真正的正常人的应力流量(2.89+/-0.50ml/min/g比2.63+/-0.61ml/min/g，p=0.005)和cfr(4.17+/-0.80vs.3.91+/-0.86，p=0.047)更高。配对研究的中位数间隔为22天(四分位数范围：15至39天)。在真实正常组中，重复性得到了改善。结论来自社区的年轻的、无症状的志愿者中有一半存在意外因素，这些因素轻微但系统性地降低了应力流、CFR和可重复性。本研究建立了FLOW和CFR的正常范围和重复性，作为临床应用的基础。(J Am Coll心脏ol IMG 2011；4：402-12)(C)2011，美国心脏病学会基金会
OBJECTIVES We sought to quantify ranges of normal myocardial perfusion and flow reserve in young, asymptomatic volunteers after systematic historical and laboratory screening for unexpected factors affecting coronary flow.BACKGROUND Noninvasive cardiac positron emission tomography (PET) quantifies absolute flow and coronary flow reserve (CFR), thereby defining physiological severity of coronary artery disease for clinical studies or management. Defining "normal" coronary flow is a necessary prerequisite to its broad clinical application.METHODS Volunteers aged 20 to 40 years of age without cardiac disease or other conditions underwent rest-dipyridamole stress cardiac PET with absolute quantitative flow measurements using Rb-82 in paired studies at least 7 days apart for reproducibility. The presence of coronary calcium, detectable blood nicotine or caffeine, dyslipidemia, and an extended family history of early clinical atherosclerosis were objectively and systematically examined for grouping subjects as true normal or not normal.RESULTS We enrolled 125 volunteers, 107 (86%) underwent 2 PET scans. Fifty-six (45%) were classified as true normal, whereas 69 (55%) were classified as not normal. True normals had higher high-density lipoprotein and less PET scan heterogeneity. Hemodynamic responses to dipyridamole stress were similar. Rest flow was the same in both groups (0.72 +/- 0.17 ml/min/g vs. 0.69 +/- 0.14 ml/min/g, p = 0.164). However, stress flow (2.89 +/- 0.50 ml/min/g vs. 2.63 +/- 0.61 ml/min/g, p = 0.005) and CFR (4.17 +/- 0.80 vs. 3.91 +/- 0.86, p = 0.047) were higher in true normals. Paired studies were performed a median of 22 days (interquartile range: 15 to 39) apart. Reproducibility was improved in the true normal group.CONCLUSIONS One-half of young, asymptomatic volunteers from the community harbor unexpected factors that mildly but systematically reduce stress flow, CFR, and reproducibility. This study establishes normal ranges and reproducibility for flow and CFR as the basis for clinical applications. (J Am Coll Cardiol Img 2011;4:402-12) (C) 2011 by the American College of Cardiology Foundation