CORONARY FLOW RESERVE: QUANTITATION OF CAD BY PET

  • Gould, K L, (PI)

Project: Research projectResearch Project

Description

A noninvasive, accurate, economical method to screen for
coronary artery disease and/or assess its severity in symptomatic
or asymptomatic individuals would permit therapy to reverse or
slow progression of coronary atheroma and prevent acute
myocardial infarction or sudden death, sixty percent of which
occur with no prior symptoms. We have shown that the sensitivity
and specificity for diagnosis of moderate to severe coronary
artery disease by standard positron emission tomography of Rb-82
or N-13 ammonia uptake (residue function) are 98% and 100%
respectively in symptomatic or asymptomatic man. However the
sensitivity for detecting mild coronary artery disease in the range
of 40-55% diameter narrowing is only 52%. Therefore, the specific aims of this proposal are to confirm
definitively in more animal and human studies under different
physiologic conditions and over a wide range of coronary flows the
hypotheses that: (a) peak myocardial uptake after bolus iv injection of Rb-82 or
N-13 ammonia occurs before significant venous egress of
tracer from the field, thereby proving the validity of our
extraction and first pass models, which are the basis of
early phase myocardial perfusion imaging.
(b) early phase myocardial perfusion images by positron
emission tomography accurately, reproducibly, and
quantitatively show relative myocardial flow distribution as
measured by microspheres and electromagnetic flow meter
in dogs.
(c) quantitative severity of stress induced defects on early
phase myocardial perfusion images by PET quantitatively
relate to and accurately predict stenosis severity in man
defined in terms of coronary stenosis flow reserve by
automated, quantitative, arteriographic analysis taking into
account all stenosis dimensions.
d) early phase myocardial perfusion imaging by PET is feasible
as a clinical routine and improves diagnostic sensitivity and
specificity to 98% or greater for stenoses in the range of
40-55% diameter narrowing in man, comparable to the
current sensitivity for moderate to severe lesions. The project will therefore result in a final, routine, quantitative,
clinically validated screening method for diagnosing and
quantifying severity of coronary artery disease in symptomatic or
asymptomatic man for stenoses ranging down to 40-55% diameter
narrowing.
StatusFinished
Effective start/end date7/1/803/31/94

Funding

  • National Institutes of Health
  • National Institutes of Health: $305,574.00
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health: $305,305.00

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Pets
Dipyridamole
Ammonia
Positron-Emission Tomography
Single-Photon Emission-Computed Tomography
Coronary Stenosis
Pathologic Constriction
Perfusion
Thallium
Dogs
Vasodilation
Angiography
Myocardial Perfusion Imaging
Accidental Falls
Microspheres
Catechols
Flowmeters
Exercise
Coronary Artery Disease
Alkalosis

Keywords

  • Medicine(all)