The diagnosis and prognosis of coronary microvascular disease using PET/CT

Article type: Research Article

Authors: Zhang, Xi^a | Li, Hui^b | Wu, Ping^c | Yuan, Lin^d | Wu, Zhifang^c | Liu, Haiyan^c | Li, Sijin^{c; *}

Affiliations: [a] Department of Nuclear Medicine, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan, China | [b] Department of Cardiology, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China | [c] Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China | [d] Department of PET/CT, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan, China

Correspondence: [*] Corresponding author: Sijin Li, Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, No. 85 of Jiefang Road, Yingze District, Taiyuan 030001, Shanxi, China. Tel.: +86 0351 4639431; E-mail: [email protected].

Abstract: OBJECTIVE:This study aimed to evaluate the diagnostic and prognostic value of 13N–NH3·H2O positron emission tomography combined with computed tomography (PET/CT) for non-obstructive coronary microvascular disease (CMVD). METHODS:A retrospective analysis was conducted on 70 patients with clinically suspected non-obstructive CMVD (35 males, 35 females) between March 2017 and August 2019. The average age of the patients was 53.32±7.82 years. The patients underwent 13N–NH3·H2O PET/CT and were divided into two groups based on diagnostic criteria: a CMVD group and a non-CMVD group. They were then followed up for 180–1,095 days. Data were analyzed using an χ2 test, the logistic regression model, the multiple linear regression model, the Kaplan–Meier method, the Cox proportional hazards regression model, and a receiver operating characteristic (ROC) curve. RESULTS:(1) The incidence of cardiovascular family history and a high calcification score (11–400) was higher in the CMVD group than in the non-CMVD group (58.8% vs. 20.8% and 29.4% vs. 5.7%, respectively; P < 0.05 for all), stress myocardial blood flow (MBF) and coronary flow reserve (CFR) values were lower in the CMVD group than in the non-CMVD group (2.280±0.693 vs. 3.641±1.365 and 2.142±0.339 vs. 3.700±1.123, respectively), and calcification score was higher in the CMVD group than in the non-CMVD group (110.18±165.07 vs. 13.21±41.68, respectively; P < 0.05 for all). Gender and diabetes were risk factors for stress MBF reduction (β= 1.287 and β= –0.636, respectively), calcification score and hypertension were risk factors for CFR reduction (β= –0.004 and β= –0.654, respectively), and hypertension, family history, and calcification score were risk factors in the CMVD group (OR = 7.323, OR = 5.108, OR = 1.012, respectively; P < 0.05 for all). (2) The prognosis of patients with CFR < 2.5 was worse than that of patients with CFR≥2.5 (x2 value: 27.404, P < 0.001). The risk of adverse cardiovascular events in diabetic patients was also increased (β= 0.328, P < 0.001). When CFR was set to 2.595, the prognostic sensitivity was 94% and the specificity was 80%. CONCLUSION:The technology of 13N–NH3·H2O PET/CT can be used for the diagnosis and prognosis of non-obstructive CMVD. Cardiovascular risk factors are related to the occurrence and prognosis of CMVD.

Keywords: Coronary microvascular disease, PET/CT, coronary flow reserve, diagnosis, prognosis

DOI: 10.3233/CH-201034

Journal: Clinical Hemorheology and Microcirculation, vol. 80, no. 2, pp. 153-166, 2022