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그림 1. 각 관상동맥별로 significant stenosis (SS)와 diffuse atherosclerosis (DA)의 유무에 따른 stress MBF, CFR, RFR의 비교. Stress MBF는 SS, DA 모두에 영향을 받으며, CFR은 둘 다 영향을 받으나 주로 DA에 영향을 받는 데 비해 RFR은 SS에 주로 영향을 받고 DA로부터는 상대적으로 독립적인 양상을 보임.

그림 2. (a), (b) MBF, CFR이 DA/SS의 유무에 따라 다양한 패턴을 보이는 반면, (c) RFR의 경우 DA의 유무와 상관없이 SS를 구별해 줄 수 있는 지표로 확인됨.

그림 3. CFR-RFR discordance에 따른 SS, DA의 분포. SS의 경우 CFR-RFR discordance pattern에 따른 분포가 유의한 차이가 없었으나, DA의 경우 주로 low CFR-preserved RFR group에 분포하는 것으로 나타남

Abstract

OBJECTIVE:

We evaluated the relationships between coronary flow reserve (CFR) and relative flow reserve (RFR) measured by N-13 ammonia positron emission tomography (PET) for characterization of epicardial coronary artery disease (CAD).

METHODS:

Sixty-nine consecutive stable angina patients underwent N-13 ammonia PET, coronary computed tomography angiography (CCTA), and if necessary, invasive coronary angiography (CAG) within 2 weeks. Myocardial blood flow (MBF), CFR, RFR, and coronary vascular resistance of the reference arterial territory (CVRref) were measured by N-13 ammonia PET. The presence of significant stenosis (SS) and diffuse atherosclerosis (DA) was evaluated on CCTA and CAG. Functional parameters measured by PET were compared among arteries with and without SS and DA.

RESULTS:

Arteries with SS and those with DA showed significantly lower stress MBF, as compared to those without. RFR was significantly lower in arteries with SS as compared to those without, while CFR was not. CFR was significantly lower in arteries with DA as compared to those without, while RFR was not. Among arteries without SS, CFR was significantly lower in those with DA as compared to those without. However, among arteries with SS, CFR was similar between those with and without DA. In contrast, RFR was significantly lower in arteries with SS, regardless of the presence of DA. CFR and RFR showed a weak positive correlation (r = 0.269) with discordance in 24 cases (35%). Among the arteries with CFR-RFR discordance, the prevalence of DA was significantly higher in those with low CFR but preserved RFR, as compared to those with preserved CFR but low RFR (75 vs 25%, p = 0.028). CVRref was significantly higher in arteries with DA, implicating a correlation of DA with underlying microvascular disease.

CONCLUSIONS:

CFR and RFR measured by myocardial perfusion PET could provide a comprehensive information for characterization of epicardial CAD.

Author information

Cho SG1, Park KS1, Kim J1, Kang SR2, Song HC1, Kim JH3, Cho JY3, Hong YJ3, Jabin Z2, Park HJ2, Jeong GC2, Kwon SY2, Paeng JC4, Kim HS2, Min JJ2, Garcia EV5, Bom HH6.​

1Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, South Korea.

2Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.

3Department of Cardiology, Chonnam National University Hospital, Gwang-ju, South Korea.

4Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.

5Nuclear Cardiology R&D Laboratory, Emory University, Atlanta, GA, USA.

6Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea. hsbom@jnu.ac.kr.