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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 2/2010

01-02-2010 | Original Article

Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes

Authors: Cecilia Marini, GianPaolo Bezante, Patrizia Gandolfo, Elisa Modonesi, Silvia D. Morbelli, Angelo DePascale, Daniela Rollando, Davide Maggi, Manuela Albertelli, Riccardo Armonino, Manrico Balbi, Claudio Brunelli, Renzo Cordera, Gianmario Sambuceti

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2010

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Abstract

Purpose

The aim of this study was to validate a new method to measure regional myocardial perfusion reserve (MPR) with technetium-labelled tracers in patients with type 2 diabetes mellitus (DM2).

Methods

A total of 40 consecutive DM2 patients without history of coronary artery disease (CAD) and 7 control subjects were recruited. Dipyridamole myocardial blood flow index (MBF) was assessed by measuring first transit counts in the pulmonary artery and myocardial count rate from gated SPECT images using 99mTc-labelled tracers. The corresponding MBF index was estimated 2 h later according to the same procedure. Regional myocardial perfusion reserve (MPR) was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular (LV) model. Coronary flow reserve (CFR) was estimated by transthoracic contrast echo Doppler monitoring of flow velocity in the left anterior descending coronary artery (LAD) during the same session.

Results

Estimated MPR was higher in control subjects than in patients (3.36 ± 0.66 vs 1.91 ± 0.61, respectively, p < 0.01). In patients, LAD CFR and LAD MPR were 2.01 ± 0.78 vs 1.93 ± 0.63, respectively (p = ns). The agreement between the two techniques was documented by their close correlation (r = 0.92, p < 0.001) and confirmed by the Bland-Altman analysis. Reversible perfusion defects occurred in 13 patients (32%) who showed similar MPR values as the remaining 27 (2.10 ± 0.71 vs 1.83 ± 0.71, respectively, p = ns). Finally, MPR was closely correlated with age (r = −0.50, p < 0.01) and time elapsed from the diagnosis of DM2 (r = −0.51, p < 0.01).

Conclusion

LV regional MPR can be accurately estimated with the broadly available single photon technology. Application of this method to DM2 patients documents the presence of a microvascular dysfunction homogeneously distributed throughout the LV walls and most frequently not associated with reversible perfusion defects.
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Metadata
Title
Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes
Authors
Cecilia Marini
GianPaolo Bezante
Patrizia Gandolfo
Elisa Modonesi
Silvia D. Morbelli
Angelo DePascale
Daniela Rollando
Davide Maggi
Manuela Albertelli
Riccardo Armonino
Manrico Balbi
Claudio Brunelli
Renzo Cordera
Gianmario Sambuceti
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-009-1316-5

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