Author + information
- Received April 26, 2016
- Revision received September 6, 2016
- Accepted September 8, 2016
- Published online December 21, 2016.
- S1936878X16308099-50013aee0d656457f3a0f1557cd9931bDanai Kitkungvan, MDa,
- S1936878X16308099-31b9d9933affd73431eb1666c6608abfNils P. Johnson, MD, MSa,
- S1936878X16308099-90a1d11ba84028a458302f9984183d34Amanda E. Roby, PET, CNMT, RT(N)b,
- S1936878X16308099-694c177da9a25d87a435d208ec1ead22Monika B. Patel, MDa,
- S1936878X16308099-870a401c967f28baf0d261c26090be82Richard Kirkeeide, PhDc and
- S1936878X16308099-415763c71fad28b452344c49c2ee8dcdK. Lance Gould, MDd,∗ ()
- aDivision of Cardiology, Department of Medicine and Weatherhead PET Center for Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, Texas
- bPET Imaging, Department of Medicine and Weatherhead PET Center for Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, Texas
- cDepartment of Medicine and Weatherhead PET Center for Preventing Atherosclerosis, McGovern Medical School, Houston, Texas
- dWeatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, Houston, Texas
- ↵∗Reprint requests and correspondence:
Dr. K. Lance Gould, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Room MSB 4.256, Houston, Texas 77030.
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 ΔSD at rest ±0.09, at stress ±0.23 cc/min/g) and for days apart is ±21% (mean ΔSD at rest ±0.2, at stress ±0.46 cc/min/g) reflecting added biological variability. Global myocardial perfusion at 8 minutes 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.
Dr. Johnson has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; has received significant institutional research support from St. Jude Medical (for NCT02184117) and Volcano/Philips Corporation (for NCT02328820), makers of intracoronary pressure and flow sensors; and has an institutional licensing and consulting agreement with Boston Scientific for the smart minimum fractional flow reserve (FFR) algorithm. Dr. Gould has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; and is the 510(k) applicant for CFR Quant (K113754) and HeartSee (K143664), software packages for cardiac positron emission tomography image processing and analysis, including absolute flow quantification. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2016.
- Revision received September 6, 2016.
- Accepted September 8, 2016.
- American College of Cardiology Foundation