Integrated myocardial flow reserve (iMFR) assessment: optimized PET blood flow quantification for diagnosis of coronary artery disease

Alexis Poitrasson-Rivière, Jonathan B. Moody, Jennifer M. Renaud, Tomoe Hagio, Liliana Arida-Moody, Christopher J. Buckley, Mouaz H. Al-Mallah, Brahmajee K. Nallamothu, Richard L. Weinberg, Edward P. Ficaro, Venkatesh L. Murthy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: Distinguishing obstructive epicardial coronary artery disease (CAD) from microvascular dysfunction and diffuse atherosclerosis would be of immense benefit clinically. However, quantitative measures of absolute myocardial blood flow (MBF) integrate the effects of focal epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. In this study, MFR and relative perfusion quantification were combined to create integrated MFR (iMFR) which was evaluated using data from a large clinical registry and an international multi-center trial and validated against invasive coronary angiography (ICA). Methods: This study included 1,044 clinical patients referred for 82Rb rest/stress positron emission tomography myocardial perfusion imaging and ICA, along with 231 patients from the Flurpiridaz 301 trial (clinicaltrials.gov NCT01347710). MFR and relative perfusion quantification were combined to create an iMFR map. The incremental value of iMFR was evaluated for diagnosis of obstructive stenosis, adjusted for patient demographics and pre-test probability of CAD. Models for high-risk anatomy (left main or three-vessel disease) were also constructed. Results: iMFR parameters of focally impaired perfusion resulted in best fitting diagnostic models. Receiver-operating characteristic analysis showed a slight improvement compared to standard quantitative perfusion approaches (AUC 0.824 vs. 0.809). Focally impaired perfusion was also associated with high-risk CAD anatomy (OR 1.40 for extent, and OR 2.40 for decreasing mean MFR). Diffusely impaired perfusion was associated with lower likelihood of obstructive CAD, and, in the absence of transient ischemic dilation (TID), with lower likelihood of high-risk CAD anatomy. Conclusions: Focally impaired perfusion extent derived from iMFR assessment is a powerful incremental predictor of obstructive CAD while diffusely impaired perfusion extent can help rule out obstructive and high-risk CAD in the absence of TID.

Original languageEnglish (US)
Pages (from-to)136-146
Number of pages11
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume51
Issue number1
Early online dateOct 9 2023
DOIs
StatePublished - Dec 2023

Keywords

  • Coronary artery disease
  • Myocardial flow reserve
  • Positron emission tomography
  • Coronary Circulation
  • Myocardial Perfusion Imaging/methods
  • Constriction, Pathologic
  • Humans
  • Clinical Trials as Topic
  • Coronary Artery Disease/diagnostic imaging
  • Fractional Flow Reserve, Myocardial
  • Multicenter Studies as Topic
  • Atherosclerosis
  • Coronary Angiography/methods
  • Positron-Emission Tomography/methods

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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