| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;93:2000-2006.)
© 1996 American Heart Association, Inc.
Articles |
Noninvasive Quantification of Myocardial Blood Flow in Humans
A Direct Comparison of the [13N]Ammonia and the [15O]Water Techniques
From the Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, UCLA School of Medicine, and Laboratory of Structural Biology and Molecular Medicine (E.U.N.), University of California, Los Angeles.
Correspondence to Heinrich R. Schelbert, MD, PhD, Department of Molecular and Medical Pharmacology, UCLA School of Medicine, Los Angeles, CA 90095-1735.
Background [13N]Ammonia has been validated in dog studies as a myocardial blood flow tracer. Estimates of myocardial blood flow by [13N]ammonia were highly linearly correlated to those by the microsphere and blood sample techniques. However, estimates of myocardial blood flow with [13N]ammonia in humans have not yet been compared with those by an independent technique. This study therefore tested the hypothesis that the [13N]ammonia positron emission tomographic technique in humans gives estimates of myocardial blood flow comparable to those obtained with the [15O]water technique.
Methods and Results A total of 30 pairs of positron emission tomographic flow measurements were performed in 30 healthy volunteers; 15 volunteers were studied at rest and 15 during adenosine-induced hyperemia. Estimates of average and of regional myocardial blood flow by the [13N]ammonia and the [15O]water approaches correlated well (y=0.02+1.02x, r=.99, P<.001, SEE=0.023 for average and y=0.06+1.00x, r=.97, P<.001, SEE=0.025 for regional values) over a flow range of 0.45 to 4.74 mL·min-1·g-1. At rest, mean myocardial blood flow was 0.64±0.09 mL·min-1·g-1 for [13N]ammonia and 0.66±0.12 mL·min-1·g-1 for [15O]water (P=NS). For adenosine-induced hyperemia, mean myocardial blood flow was 2.63±0.75 mL·min-1·g-1 for [13N]ammonia and 2.73±0.77 mL·min-1·g-1 for [15O]water (P=NS). The coefficient of variation as an index of the observed heterogeneity of myocardial blood flow averaged, for [13N]ammonia, 9±4% at rest and 12±7% during stress and, for [15O]water, 14±11% at rest and 16±9% during stress. The coefficients of variation for [15O]water were significantly higher than those for [13N]ammonia (P=.004 at rest and P=.03 during stress).
Conclusions The two approaches yield comparable estimates of myocardial blood flow in humans, which supports the validity of the [13N]ammonia method in human myocardium previously shown only in animals. However, the [15O]water approach reveals a greater heterogeneity (presumably method-related), which might limit the accuracy of sectorial myocardial blood flow estimates in humans.
Key Words: blood flow • tomography • imaging • [13N]ammonia • [15O]water
This article has been cited by other articles:
 |
|
 |
|
  G. El Fakhri, A. Kardan, A. Sitek, S. Dorbala, N. Abi-Hatem, Y. Lahoud, A. Fischman, M. Coughlan, T. Yasuda, and M. F. Di Carli Reproducibility and Accuracy of Quantitative Myocardial Blood Flow Assessment with 82Rb PET: Comparison with 13N-Ammonia PET J. Nucl. Med., July 1, 2009; 50(7): 1062 - 1071. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Neglia and A. L'Abbate Myocardial Perfusion Reserve in Ischemic Heart Disease J. Nucl. Med., February 1, 2009; 50(2): 175 - 177. [Full Text] [PDF]
|
|
|
|
|
|
G. P. Chen, K. R. Branch, A. M. Alessio, P. Pham, R. Tabibiazar, P. Kinahan, and J. H. Caldwell Effect of Reconstruction Algorithms on Myocardial Blood Flow Measurement with 13N-Ammonia PET J. Nucl. Med., August 1, 2007; 48(8): 1259 - 1265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Di Carli, S. Dorbala, J. Meserve, G. El Fakhri, A. Sitek, and S. C. Moore Clinical Myocardial Perfusion PET/CT J. Nucl. Med., May 1, 2007; 48(5): 783 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Chareonthaitawee, S. D. Christenson, J. L. Anderson, B. J. Kemp, D. O. Hodge, E. L. Ritman, and R. J. Gibbons Reproducibility of Measurements of Regional Myocardial Blood Flow in a Model of Coronary Artery Disease: Comparison of H215O and 13NH3 PET Techniques J. Nucl. Med., July 1, 2006; 47(7): 1193 - 1201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. N. Tipre and D. S. Goldstein Cardiac and Extracardiac Sympathetic Denervation in Parkinson's Disease with Orthostatic Hypotension and in Pure Autonomic Failure J. Nucl. Med., November 1, 2005; 46(11): 1775 - 1781. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Schindler, E. U. Nitzsche, H. R. Schelbert, M. Olschewski, J. Sayre, M. Mix, I. Brink, X.-L. Zhang, M. Kreissl, N. Magosaki, et al. Positron Emission Tomography-Measured Abnormal Responses of Myocardial Blood Flow to Sympathetic Stimulation Are Associated With the Risk of Developing Cardiovascular Events J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1505 - 1512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Mishra, S. Dorbala, G. Logsetty, A. Hassan, T. Heinonen, H. R. Schelbert, M. F. Di Carli, and RAMPART Investigators Quantitative relation between hemodynamic changes during intravenous adenosine infusion and the magnitude of coronary hyperemia: Implications for myocardial perfusion imaging J. Am. Coll. Cardiol., February 15, 2005; 45(4): 553 - 558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Jagathesan, P. A. Kaufmann, S. D. Rosen, O. E. Rimoldi, F. Turkeimer, R. Foale, and P. G. Camici Assessment of the Long-Term Reproducibility of Baseline and Dobutamine-Induced Myocardial Blood Flow in Patients with Stable Coronary Artery Disease J. Nucl. Med., February 1, 2005; 46(2): 212 - 219. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Kaufmann and P. G. Camici Myocardial Blood Flow Measurement by PET: Technical Aspects and Clinical Applications J. Nucl. Med., January 1, 2005; 46(1): 75 - 88. [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Schindler, E. U. Nitzsche, M. Olschewski, N. Magosaki, M. Mix, J. O. Prior, A. D. Facta, U. Solzbach, H. Just, and H. R. Schelbert Chronic Inflammation and Impaired Coronary Vasoreactivity in Patients With Coronary Risk Factors Circulation, August 31, 2004; 110(9): 1069 - 1075. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Janatuinen, J. Knuuti, J. O. Toikka, M. Ahotupa, P. Nuutila, T. Ronnemaa, and O. T. Raitakari Effect of Pravastatin on Low-Density Lipoprotein Oxidation and Myocardial Perfusion in Young Adults With Type 1 Diabetes Arterioscler Thromb Vasc Biol, July 1, 2004; 24(7): 1303 - 1308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Schindler, E. U. Nitzsche, M. Olschewski, I. Brink, M. Mix, J. Prior, A. Facta, M. Inubushi, H. Just, and H. R. Schelbert PET-Measured Responses of MBF to Cold Pressor Testing Correlate with Indices of Coronary Vasomotion on Quantitative Coronary Angiography J. Nucl. Med., March 1, 2004; 45(3): 419 - 428. [Abstract] [Full Text]
|
|
|
|
|
|
S.-T. Li, C. Holmes, I. J. Kopin, and D. S. Goldstein Aging-Related Changes in Cardiac Sympathetic Function in Humans, Assessed by 6-18F-Fluorodopamine PET Scanning J. Nucl. Med., October 1, 2003; 44(10): 1599 - 1603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Schindler, E. U. Nitzsche, T. Munzel, M. Olschewski, I. Brink, M. Jeserich, M. Mix, P. T. Buser, M. Pfisterer, U. Solzbach, et al. Coronary vasoregulation in patients with various risk factors in response to cold pressor testing: Contrasting myocardial blood flow responses to short- and long-term vitamin C administration J. Am. Coll. Cardiol., September 3, 2003; 42(5): 814 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T H Schindler, E Nitzsche, N Magosaki, I Brink, M Mix, M Olschewski, U Solzbach, and H Just Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation Heart, May 1, 2003; 89(5): 517 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Wyss, P. Koepfli, K. Mikolajczyk, C. Burger, G. K. von Schulthess, and P. A. Kaufmann Bicycle Exercise Stress in PET for Assessment of Coronary Flow Reserve: Repeatability and Comparison with Adenosine Stress J. Nucl. Med., February 1, 2003; 44(2): 146 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G Camici and O. E Rimoldi Myocardial blood flow in patients with hibernating myocardium Cardiovasc Res, February 1, 2003; 57(2): 302 - 311. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Koskenvuo, J. J. Hartiala, J. Knuuti, H. Sakuma, J. O. Toikka, M. Komu, M. Saraste, and P. Niemi Assessing Coronary Sinus Blood Flow in Patients with Coronary Artery Disease: A Comparison of Phase-Contrast MR Imaging with Positron Emission Tomography Am. J. Roentgenol., November 1, 2001; 177(5): 1161 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sakuma, J. W. Koskenvuo, P. Niemi, N. Kawada, J. O. Toikka, J. Knuuti, H. Laine, M. Saraste, M. Kormano, and J. J. Hartiala Assessment of Coronary Flow Reserve Using Fast Velocity-Encoded Cine MR Imaging: Validation Study Using Positron Emission Tomography Am. J. Roentgenol., October 1, 2000; 175(4): 1029 - 1033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Kaufmann, T. Gnecchi-Ruscone, M. di Terlizzi, K. P. Schafers, T. F. Luscher, and P. G. Camici Coronary Heart Disease in Smokers : Vitamin C Restores Coronary Microcirculatory Function Circulation, September 12, 2000; 102(11): 1233 - 1238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-T. Li, C. J. Tack, L. Fananapazir, and D. S. Goldstein Myocardial perfusion and sympathetic innervation in patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1867 - 1873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S R Redwood, R Ferrari, and M S Marber Myocardial hibernation and stunning: from physiological principles to clinical practice Heart, September 1, 1998; 80(3): 218 - 222. [Full Text]
|
|
|
|
|
|
P. G. Camici, W. Wijns, M. Borgers, R. De Silva, R. Ferrari, J. Knuuti, A. A. Lammertsma, A. J. Liedtke, G. Paternostro, and S. F. Vatner Pathophysiological Mechanisms of Chronic Reversible Left Ventricular Dysfunction due to Coronary Artery Disease (Hibernating Myocardium) Circulation, November 4, 1997; 96(9): 3205 - 3214. [Full Text]
|
|
|
|
|
|
S. H. Rahimtoola Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine Circulation, December 15, 1996; 94(12): 3055 - 3061. [Full Text]
|
|