150.00 rub.
Buy article

Myocardial Perfusion Imaging Modalities: What do we Really see?

Ansheles A. A., Sergienko V. B.
Russian Cardiology Research and Production Complex, Moscow, Russia

Keywords: radiology; myocardium; perfusion; viability

DOI: 10.18087/cardio.2017.7.10000

Assessment of perfusion, severity of ischemia and the volume of viable myocardium, including single-photon or positron emission tomography (SPECT and PET) is one of the most important stages of examination of patients with ischemic heart disease. However, in recent years “perfusion” prefix was added to other cardiologic modalities (echocardiography, magnetic resonance and computed tomography). Such a terminological uncertainty leads cardiologists to an erroneous evaluation of real possibilities of these methods. The review clarifies the definitions of terms “perfusion”, “ischemia”, and “viability” of the myocardium. Imaging modalities are compared from the perspective of compliance with the kinetics of the indicators used and actually visualized myocardial processes.
  1. Montalescot G., Sechtem U., Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949–3003.
  2. Le Bihan D., Turner R. The capillary network: a link between IVIM and classical perfusion. Magn Reson Med 1992;27(1):171–178.
  3. Schmitt F., Stehling M.K., Turner R. Echo-Planar Imaging: Theory, Technique and Application. Springer, 1998.
  4. Schneider M. Characteristics of SonoVuetrade mark. Echocardiography 1999;16(7 Pt 2):743–746.
  5. Saeed M., Hetts S.W., Jablonowski R ., Wilson M.W. Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies. World J Cardiol 2014;6(11):1192–1208.
  6. McKillop J.H. Thallium 201 scintigraphy. West J Med 1980;133(1):26–43.
  7. Boden W.E., O’Rourke R.A., Teo K.K. et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356(15):1503–1516.
  8. Hachamovitch R., Hayes S.W., Friedman J.D. et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107(23):2900–2907.
  9. Hachamovitch R., Di Carli M.F. Methods and limitations of assessing new noninvasive tests: Part II: Outcomes-based validation and reliability assessment of noninvasive testing. Circulation 2008;117(21):2793–2801.
  10. Tonino P.A., De Bruyne B., Pijls N.H. et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360(3):213–224.
  11. Majmudar M.D., Nahrendorf M. Cardiovascular molecular imaging: the road ahead. J Nucl Med 2012;53(5):673–676.
  12. Sato A., Hiroe M., Tamura M. et al. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med 2008;49(4):564–572.
  13. Ansheles A.A., Shulgin D.N., Solomyany V.V., Sergienko V.B. Comparison of stress-test, single-photon emission computed tomography, and coronarography results in IHD patients. Kardiologicheskij Vestnik 2012;2:10–17. Russian (Аншелес А. А., Шульгин Д. Н., Соломяный В. В., Сергиенко В. Б. Сопоставление результатов нагрузочных проб, данных однофотонной эмиссионной компьютерной томографии миокарда и коронарографии у больных ишемической болезнью сердца. Кардиологический вестник 2012;2:10–17).
  14. van Nunen L.X., Zimmermann F.M., Tonino P.A. et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015;386(10006):1853–1860.
  15. Johnson N.P., Gould K.L. Fractional Flow Reserve Returns to Its Origins: Quantitative Cardiac Positron Emission Tomography. Circ Cardiovasc Imaging 2016;9(9).
  16. Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35(37):2541–2619.
  17. Sergienko V.B., Sayutina E.V., Samoilenko L.E. et al. The role of endothelial dysfunction in the development of myocardial ischemia in patients with coronary heart disease and intact or initially changed coronary arteries. Kardiologiia 1999;39(1):25–30. Russian (Сергиенко В. Б., Саютина Е. В., Самойленко Л. Е. и др. Роль дисфункции эндотелия в развитии ишемии миокарда у больных ишемической болезнью сердца с неизмененными и малоизмененными коронарными артериями. Кардиология 1999;39(1):25–30).
  18. Gibbons R.J., Hodge D.O., Berman D.S. et al. Long-term outcome of patients with intermediate-risk exercise electrocardiograms who do not have myocardial perfusion defects on radionuclide imaging. Circulation 1999;100(21):2140–2145.
  19. Bonow R.O., Maurer G., Lee K.L. et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 2011;364(17):1617–1625.
  20. Gulya M.O., Lishmanov Yu.B., Zavadovsky K.V., Lebedev D.I. Metabolism of fatty acids in left ventricle myocardium and the efficacy prognosis of cardio-resynchronizing therapy in dilated cardiomyopathy patients. Russian Journal of Cardiology 2014;113(9):61–67. Russian (Гуля М. О., Лишманов Ю. Б., Завадовский К. В., Лебедев Д. И. Состояние метаболизма жирных кислот в миокарде левого желудочка и прогноз эффективности кардиоресинхронизирующей терапии у пациентов с дилатационной кардиомиопатией. Российский кардиологический журнал 2014;113(9):61–67).
  21. Ghosh N., Rimoldi O.E., Beanlands R .S., Camici P.G. Assessment of myocardial ischaemia and viability: role of positron emission tomography. Eur Heart J 2010;31(24):2984–2995.
  22. Lishmanov Yu.B., Yefimova I.Yu., Chernov V.I. et al. Scintigraphy as a tool of diagnosis, prevention and monitoring of cardiac diseases treatment. Siberian Medical Journal 2007;22(3):74–77. Russian (Лишманов Ю. Б., Ефимова И. Ю., Чернов В. И. и др. Сцинтиграфия как инструмент диагностики, прогнозирования и мониторинга лечения болезней сердца. Сибирский медицинский журнал 2007;22(3):74–77).
  23. Sergienko V.B., Ansheles A.A. Tomographic methods in the assessment of myocardial perfusion. Vestnik rentgenologii i radiologii 2010;3:10–14. Russian (Сергиенко В. Б., Аншелес А. А. Томографические методы в оценке перфузии миокарда. Вестник рентгенологии и радиологии 2010;3:10–14).
  24. Shrestha U., Sciammarella M., Alhassen F. et al. Measurement of absolute myocardial blood flow in humans using dynamic cardiac SPECT and 99mTc-tetrofosmin: Method and validation. J Nucl Cardiol 2017; 24(1):268–277
  25. Mochula A.V., Zavadovsky K.V., Lishmanov Y.B. Method for Studying the Myocardial Blood Flow Reserve by Load Dynamic Single-Photon Emission Computed Tomography. Bull Exp Biol Med 2015;160(12):845–848. Russian (Мочула А. В., Завадовский К. В., Лишманов Ю. Б. Методика определения резерва миокардиального кровотока с использованием нагрузочной динамической однофотонной эмиссионной компьютерной томографии. Бюллетень экспериментальной биологии и медицины 2015;160(12):845–848).
  26. Ansheles A.A., Mironov S.P., Shul’gin D. N., Sergienko V.B. Myocardial perfusion spect with CT-based attenuation correction: data acquisition and interpretation (guidelines). Luchevaya diagnostika i terapiya 2016;7(3):87–101. Russian (Аншелес А. А., Миронов С. П., Шульгин Д. Н., Сергиенко В. Б. Перфузионная ОЭКТ миокарда с КТ-коррекцией поглощения: принципы получения и интерпретации данных (методические рекомендации). Лучевая диагностика и терапия 2016;7(3):87–101).
  27. Husmann L., Herzog B.A., Gaemperli O., et al. Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 2009;30(5):600–607.
  28. Florian A., Jurcut R., Ginghina C., Bogaert J. Cardiac magnetic resonance imaging in ischemic heart disease: a clinical review. J Med Life 2011;4(4):330–345.
  29. Hulten E., Ahmadi A., Blankstein R . CT Assessment of Myocardial Perfusion and Fractional Flow Reserve. Prog Cardiovasc Dis 2015;57(6):623–631.
  30. Lee J.H., Han D., Danad I. et al. Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography. J Cardiovasc Ultrasound 2016;24(1):7–17.
  31. Bamberg F., Marcus R .P., Becker A. et al. Dynamic myocardial CT perfusion imaging for evaluation of myocardial ischemia as determined by MR imaging. JACC Cardiovasc Imaging 2014;7(3):267–277.
  32. Pesenti-Rossi D., Peyrou J., Baron N., et al. Cardiac MRI: technology, clinical applications, and future directions. Ann Cardiol Angeiol (Paris) 2013;62(5):326–341.
Ansheles A. A., Sergienko V. B. Myocardial Perfusion Imaging Modalities: What do we Really see? Kardiologiia. 2017;57(7):5–12.

To access this material please log in or register

Register Authorize
Ru En