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Coronary blood flow reserve PowerPoint Presentation

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Description : Myocardial blood flow and coronary reserve measurements with PET

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Published on : Sep 08, 2020 | Views : 1939 | Downloads : 4

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Slide 1-

Myocardial blood flow and coronary reserve measurements with PET
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Myocardial Blood Flow Resting myocardial blood flow (MBF) is the absolute amount of blood flow that the myocardium receives per minute per gram of tissue under baseline conditions. It is affected by several factors including: age, gender, haemoglobin content, heart rate, blood pressure, drugs, myocardial contractility, cardiac work
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Myocardial Blood Flow In normal individuals, average values of MBF at rest are 0.6 to 1.3 mL/min/g (average = 0.98 ± 0.23 mL/min/g). There is a linear association between resting MBF and age.
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Myocardial Blood Flow Resting myocardial blood flow (MBF) is the absolute amount of blood flow that the myocardium receives per minute per gram of tissue under baseline conditions. It is affected by several factors including: age, gender, haemoglobin content, heart rate, blood pressure, drugs, myocardial contractility, cardiac work
Slide 5-

Myocardial Blood Flow Resting myocardial blood flow (MBF) is the absolute amount of blood flow that the myocardium receives per minute per gram of tissue under baseline conditions. It is affected by several factors including: age, gender, haemoglobin content, heart rate, blood pressure, drugs, myocardial contractility, cardiac work
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Hyperaemic Blood Flow Hyperaemic blood flow (or stress flow) represents the maximum blood flow that can be supplied to the heart during maximum vasodilatation of the coronary vascular bed. This is achieved by intravenous pharmacologic agents, such as vasodilators or inotropic agents.
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Coronary Flow Reserve Coronary Flow Reserve (CFR) constitutes the ratio of MBF during maximal coronary vasodilatation to resting MBF. It is impacted by both rest and stress flow. CFR represents the relative reserve of the coronary circulation. The optimal cut-point between normal and abnormal has been somewhat empirical and there is some variability in the literature in part depending on the flow tracer applied and on different software.
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Epicardial Vessels and the Microvasculature
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Fractional Flow Reserve Pressure-derived flow surrogate “Stress test” of an artery in the cath lab Distal coronary pressure FFR = ---------------------------------- Proximal coronary pressure
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Coronary Flow Reserve Generally it is accepted that CFR values can be interpreted as follows: CFR more than 2.3 indicates a favourable prognosis (assuming that there is no lower regional value). CFR less than 1.5 suggests significantly diminished flow reserve (in the absence of concomitant elevated resting blood flow), and is associated with elevated cardiac risk.
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Coronary Flow Reserve: Uses According to the ASNC guidelines, CFR with PET appear most helpful in: Patients without known prior history of cardiac disease who present with symptoms suspicious for myocardial ischemia; Patients with known CAD, in whom more specific physiological assessment is desired; Identifying an increased suspicion for multi-vessel CAD; Situations with a disparity between visual perfusion abnormalities and apparently normal coronary angiography, in order to assess possible microvascular dysfunction; Heart transplant, when there is a question of vasculopathy.
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PET Tracers of Myocardial Blood Flow
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Advantages and Disadvantages of PETTracers: Oxygen-15 Water Advantages: Net-tracer uptake perfectly correlates with myocardial blood flow also in the high range of coronary flows (“no roll-off phenomenon”). Short physical half-life Disadvantages: 15O-water distributes into the water spaces of myocardium and blood pool. This necessitates a subtraction of the blood pool from the 15O water images. This leads to statistically low-count images of the myocardium.
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Advantages and Disadvantages of PETTracers: N-13 Ammonia Advantages: Selectively retained by the myocardial cells and physical half-life of 9.8 min. This yields statistically high count images of the myocardium. Retention of N-13 ammonia by myocardial cells affords the application of a 2-compartment model to reliably quantify. Disadvantages: Relatively long physical half-life that necessitates longer time intervals (45 minutes) between repeat assessments of MBF. Non-linear net-tracer uptake in particular in the higher coronary flow range (“roll-off phenomenon”).
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Advantages and Disadvantages of PETTracers: 82-Rubidium Advantages: Ultra-short physical half-life. Serial investigations of myocardial perfusion at short time intervals (i.e. 10 minutes) Retention of 82-Rb by myocardial cells leads to statistically high count images of the myocardium and MBF quantification. Disadvantages: Ultra-short physical half-life forcing injection of relatively a relatively high dose of 82-Rb necessary for statistically high count Non-linear net-tracer uptake in particular in the higher coronary flow range (“roll-off phenomenon”).
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Advantages and Disadvantages of PETTracers: Flurpiridaz F18 Advantages: Relatively long physical half-life of 110 min. Flurpiridaz exhibits high resolution and extraction characteristics similar to N-13 ammonia. Less non-linear net-tracer uptake in particular in the higher coronary flow range (“roll-off phenomenon”) than N-13 ammonia and 82-Rubium myocardial blood flow quantification. Disadvantages: Relatively long physical half-life of 110 min. 2-days protocol or 1 day protocol with 3x higher dose injection for second perfusion measurement. Radiotracer correction for myocardial blood flow quantification of second exam is necessary.
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