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The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study
AIMS: Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [(1...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159743/ https://www.ncbi.nlm.nih.gov/pubmed/34878102 http://dx.doi.org/10.1093/ehjci/jeab263 |
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author | de Winter, Ruben W Jukema, Ruurt A van Diemen, Pepijn A Schumacher, Stefan P Driessen, Roel S Stuijfzand, Wynand J Everaars, Henk Bom, Michiel J van Rossum, Albert C van de Ven, Peter M Verouden, Niels J Nap, Alexander Raijmakers, Pieter G Danad, Ibrahim Knaapen, Paul |
author_facet | de Winter, Ruben W Jukema, Ruurt A van Diemen, Pepijn A Schumacher, Stefan P Driessen, Roel S Stuijfzand, Wynand J Everaars, Henk Bom, Michiel J van Rossum, Albert C van de Ven, Peter M Verouden, Niels J Nap, Alexander Raijmakers, Pieter G Danad, Ibrahim Knaapen, Paul |
author_sort | de Winter, Ruben W |
collection | PubMed |
description | AIMS: Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [(15)O]H(2)O positron emission tomography (PET) perfusion imaging. METHODS AND RESULTS: A total of 314 patients with stable CAD underwent [(15)O]H(2)O PET imaging at baseline and after myocardial revascularization to assess changes in hMBF, CFR, and CFC in 415 revascularized vessels. Using thresholds for ischaemia and normal perfusion, vessels were stratified in five CFC categories: myocardial steal, severely reduced CFC, moderately reduced CFC, minimally reduced CFC, and normal flow. Additionally, the association between CFC increase and the composite endpoint of death and non-fatal myocardial infarction (MI) was studied. Vessel-specific CFC improved after revascularization (P < 0.01). Furthermore, baseline CFC was an independent predictor of CFC increase (P < 0.01). The largest changes in ΔhMBF (0.90 ± 0.74, 0.93 ± 0.65, 0.79 ± 0.74, 0.48 ± 0.61, and 0.29 ± 0.66 mL/min/g) and ΔCFR (1.01 ± 0.88, 0.99 ± 0.69, 0.87 ± 0.88, 0.66 ± 0.91, and −0.01 ± 1.06) were observed in vessels with lower baseline CFC (P < 0.01 for both). During a median follow-up of 3.5 (95% CI 3.1–3.9) years, an increase in CFC was independently associated with lower rates of death and non-fatal MI (HR 0.43, 95% CI 0.19–0.98, P = 0.04). CONCLUSION: Successful revascularization results in an increase in CFC. Furthermore, baseline CFC was an independent predictor of change in hMBF, CFR, and subsequently CFC. In addition, an increase in CFC was associated with a favourable outcome in terms of death and non-fatal MI. |
format | Online Article Text |
id | pubmed-9159743 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-91597432022-06-05 The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study de Winter, Ruben W Jukema, Ruurt A van Diemen, Pepijn A Schumacher, Stefan P Driessen, Roel S Stuijfzand, Wynand J Everaars, Henk Bom, Michiel J van Rossum, Albert C van de Ven, Peter M Verouden, Niels J Nap, Alexander Raijmakers, Pieter G Danad, Ibrahim Knaapen, Paul Eur Heart J Cardiovasc Imaging Original Paper AIMS: Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [(15)O]H(2)O positron emission tomography (PET) perfusion imaging. METHODS AND RESULTS: A total of 314 patients with stable CAD underwent [(15)O]H(2)O PET imaging at baseline and after myocardial revascularization to assess changes in hMBF, CFR, and CFC in 415 revascularized vessels. Using thresholds for ischaemia and normal perfusion, vessels were stratified in five CFC categories: myocardial steal, severely reduced CFC, moderately reduced CFC, minimally reduced CFC, and normal flow. Additionally, the association between CFC increase and the composite endpoint of death and non-fatal myocardial infarction (MI) was studied. Vessel-specific CFC improved after revascularization (P < 0.01). Furthermore, baseline CFC was an independent predictor of CFC increase (P < 0.01). The largest changes in ΔhMBF (0.90 ± 0.74, 0.93 ± 0.65, 0.79 ± 0.74, 0.48 ± 0.61, and 0.29 ± 0.66 mL/min/g) and ΔCFR (1.01 ± 0.88, 0.99 ± 0.69, 0.87 ± 0.88, 0.66 ± 0.91, and −0.01 ± 1.06) were observed in vessels with lower baseline CFC (P < 0.01 for both). During a median follow-up of 3.5 (95% CI 3.1–3.9) years, an increase in CFC was independently associated with lower rates of death and non-fatal MI (HR 0.43, 95% CI 0.19–0.98, P = 0.04). CONCLUSION: Successful revascularization results in an increase in CFC. Furthermore, baseline CFC was an independent predictor of change in hMBF, CFR, and subsequently CFC. In addition, an increase in CFC was associated with a favourable outcome in terms of death and non-fatal MI. Oxford University Press 2021-12-08 /pmc/articles/PMC9159743/ /pubmed/34878102 http://dx.doi.org/10.1093/ehjci/jeab263 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Paper de Winter, Ruben W Jukema, Ruurt A van Diemen, Pepijn A Schumacher, Stefan P Driessen, Roel S Stuijfzand, Wynand J Everaars, Henk Bom, Michiel J van Rossum, Albert C van de Ven, Peter M Verouden, Niels J Nap, Alexander Raijmakers, Pieter G Danad, Ibrahim Knaapen, Paul The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title | The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title_full | The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title_fullStr | The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title_full_unstemmed | The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title_short | The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)O]H(2)O positron emission tomography perfusion imaging study |
title_sort | impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [(15)o]h(2)o positron emission tomography perfusion imaging study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159743/ https://www.ncbi.nlm.nih.gov/pubmed/34878102 http://dx.doi.org/10.1093/ehjci/jeab263 |
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