Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease: A quantitative analysis of clinical 82Rb PET/CT studies

Kenji Fukushima, Mehrbod Som Som Javadi, Takahiro Higuchi, Paco E. Bravo, David Chien, Riikka Lautamak̈i, Jennifer Merrill, Stephan G. Nekolla, Frank M. Bengel

Research output: Contribution to journalArticle

Abstract

Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical 82Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease. Methods: Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress 82Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m 2. After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score > 4), or reduced LV function (LV ejection fraction <45%) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n = 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for 82Rb extraction. Rest MBF was normalized to rate-pressure product. Results: Mean eGFR in the CKD group was reduced (44 ± 14 vs. 99 ± 28 mL/min/1.73 m 2; P <0.0001), and creatinine was significantly elevated, compared with controls (1.9 ± 1.1 vs. 0.8 ± 0.2 mg/dL; P <0.0001). MFR was significantly reduced in CKD (2.2 ± 1.0 vs. 3.0 ± 1.2 for controls; P = 0.027). This reduction was mainly due to increased rest MBF (1.1 ± 0.4 in CKD vs. 0.8 ± 0.2 mL/min/g in controls; P = 0.007). Stress myocardial flow was comparable between both groups (2.3 ± 0.9 vs. 2.3 ± 0.8 mL/min/g; P = 0.08). Overall, MFR was significantly correlated with eGFR (r = 0.41; P = 0.0005). Stress MBF did not correlate with eGFR (r = 0.002; P = 0.45), but rest MBF showed an inverse correlation (r = -0.49; P <0.0001). Rest MBF was also inversely correlated with hemoglobin (r = -0.28; P = 0.014), but only eGFR was an independent correlate at multivariate analysis. Conclusion: MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.

Original languageEnglish (US)
Pages (from-to)887-893
Number of pages7
JournalJournal of Nuclear Medicine
Volume53
Issue number6
DOIs
StatePublished - Jun 2012

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Chronic Renal Insufficiency
Left Ventricular Function
Perfusion
Glomerular Filtration Rate
Coronary Artery Disease
Microcirculation
Stroke Volume
Renal Insufficiency
Coronary Disease
Renal Dialysis
Disease Progression
Creatinine
Hemoglobins
Cardiovascular Diseases
Multivariate Analysis
Hemodynamics
Transplants
Kidney
Pressure
Control Groups

Keywords

  • Chronic kidney disease
  • Coronary artery disease
  • Myocardial blood flow
  • Positron emission tomography
  • Renal dysfunction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease : A quantitative analysis of clinical 82Rb PET/CT studies. / Fukushima, Kenji; Javadi, Mehrbod Som Som; Higuchi, Takahiro; Bravo, Paco E.; Chien, David; Lautamak̈i, Riikka; Merrill, Jennifer; Nekolla, Stephan G.; Bengel, Frank M.

In: Journal of Nuclear Medicine, Vol. 53, No. 6, 06.2012, p. 887-893.

Research output: Contribution to journalArticle

Fukushima, Kenji ; Javadi, Mehrbod Som Som ; Higuchi, Takahiro ; Bravo, Paco E. ; Chien, David ; Lautamak̈i, Riikka ; Merrill, Jennifer ; Nekolla, Stephan G. ; Bengel, Frank M. / Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease : A quantitative analysis of clinical 82Rb PET/CT studies. In: Journal of Nuclear Medicine. 2012 ; Vol. 53, No. 6. pp. 887-893.
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abstract = "Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical 82Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease. Methods: Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress 82Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m 2. After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score > 4), or reduced LV function (LV ejection fraction <45{\%}) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n = 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for 82Rb extraction. Rest MBF was normalized to rate-pressure product. Results: Mean eGFR in the CKD group was reduced (44 ± 14 vs. 99 ± 28 mL/min/1.73 m 2; P <0.0001), and creatinine was significantly elevated, compared with controls (1.9 ± 1.1 vs. 0.8 ± 0.2 mg/dL; P <0.0001). MFR was significantly reduced in CKD (2.2 ± 1.0 vs. 3.0 ± 1.2 for controls; P = 0.027). This reduction was mainly due to increased rest MBF (1.1 ± 0.4 in CKD vs. 0.8 ± 0.2 mL/min/g in controls; P = 0.007). Stress myocardial flow was comparable between both groups (2.3 ± 0.9 vs. 2.3 ± 0.8 mL/min/g; P = 0.08). Overall, MFR was significantly correlated with eGFR (r = 0.41; P = 0.0005). Stress MBF did not correlate with eGFR (r = 0.002; P = 0.45), but rest MBF showed an inverse correlation (r = -0.49; P <0.0001). Rest MBF was also inversely correlated with hemoglobin (r = -0.28; P = 0.014), but only eGFR was an independent correlate at multivariate analysis. Conclusion: MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.",
keywords = "Chronic kidney disease, Coronary artery disease, Myocardial blood flow, Positron emission tomography, Renal dysfunction",
author = "Kenji Fukushima and Javadi, {Mehrbod Som Som} and Takahiro Higuchi and Bravo, {Paco E.} and David Chien and Riikka Lautamak̈i and Jennifer Merrill and Nekolla, {Stephan G.} and Bengel, {Frank M.}",
year = "2012",
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doi = "10.2967/jnumed.111.099325",
language = "English (US)",
volume = "53",
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journal = "Journal of Nuclear Medicine",
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TY - JOUR

T1 - Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease

T2 - A quantitative analysis of clinical 82Rb PET/CT studies

AU - Fukushima, Kenji

AU - Javadi, Mehrbod Som Som

AU - Higuchi, Takahiro

AU - Bravo, Paco E.

AU - Chien, David

AU - Lautamak̈i, Riikka

AU - Merrill, Jennifer

AU - Nekolla, Stephan G.

AU - Bengel, Frank M.

PY - 2012/6

Y1 - 2012/6

N2 - Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical 82Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease. Methods: Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress 82Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m 2. After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score > 4), or reduced LV function (LV ejection fraction <45%) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n = 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for 82Rb extraction. Rest MBF was normalized to rate-pressure product. Results: Mean eGFR in the CKD group was reduced (44 ± 14 vs. 99 ± 28 mL/min/1.73 m 2; P <0.0001), and creatinine was significantly elevated, compared with controls (1.9 ± 1.1 vs. 0.8 ± 0.2 mg/dL; P <0.0001). MFR was significantly reduced in CKD (2.2 ± 1.0 vs. 3.0 ± 1.2 for controls; P = 0.027). This reduction was mainly due to increased rest MBF (1.1 ± 0.4 in CKD vs. 0.8 ± 0.2 mL/min/g in controls; P = 0.007). Stress myocardial flow was comparable between both groups (2.3 ± 0.9 vs. 2.3 ± 0.8 mL/min/g; P = 0.08). Overall, MFR was significantly correlated with eGFR (r = 0.41; P = 0.0005). Stress MBF did not correlate with eGFR (r = 0.002; P = 0.45), but rest MBF showed an inverse correlation (r = -0.49; P <0.0001). Rest MBF was also inversely correlated with hemoglobin (r = -0.28; P = 0.014), but only eGFR was an independent correlate at multivariate analysis. Conclusion: MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.

AB - Impaired global myocardial flow reserve (MFR) may be associated with increased risk for cardiac events and coronary artery disease progression. Chronic kidney disease (CKD) is also considered a risk factor for cardiovascular disease. We sought to investigate the effect of CKD on the myocardial microcirculation in patients referred for clinical 82Rb PET/CT, who had normal left ventricular (LV) function and no flow-limiting coronary artery disease. Methods: Estimated glomerular filtration rate (eGFR) was available for 230 patients who had undergone rest and pharmacologic stress 82Rb PET/CT for suspected coronary artery disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m 2. After patients with hemodialysis, a renal transplant, abnormal regional perfusion (summed stress score > 4), or reduced LV function (LV ejection fraction <45%) were excluded, 40 CKD patients remained. Those were compared with a control group without CKD, which was matched for age, sex, coronary risk factors, and systemic hemodynamics (n = 42). List-mode acquisition of PET enabled quantification of myocardial blood flow (MBF) and MFR using a previously validated retention model with correction for 82Rb extraction. Rest MBF was normalized to rate-pressure product. Results: Mean eGFR in the CKD group was reduced (44 ± 14 vs. 99 ± 28 mL/min/1.73 m 2; P <0.0001), and creatinine was significantly elevated, compared with controls (1.9 ± 1.1 vs. 0.8 ± 0.2 mg/dL; P <0.0001). MFR was significantly reduced in CKD (2.2 ± 1.0 vs. 3.0 ± 1.2 for controls; P = 0.027). This reduction was mainly due to increased rest MBF (1.1 ± 0.4 in CKD vs. 0.8 ± 0.2 mL/min/g in controls; P = 0.007). Stress myocardial flow was comparable between both groups (2.3 ± 0.9 vs. 2.3 ± 0.8 mL/min/g; P = 0.08). Overall, MFR was significantly correlated with eGFR (r = 0.41; P = 0.0005). Stress MBF did not correlate with eGFR (r = 0.002; P = 0.45), but rest MBF showed an inverse correlation (r = -0.49; P <0.0001). Rest MBF was also inversely correlated with hemoglobin (r = -0.28; P = 0.014), but only eGFR was an independent correlate at multivariate analysis. Conclusion: MFR is impaired in patients with renal insufficiency with normal regional perfusion and LV function, mostly because of elevated rest flow. Absolute quantification of flow may be useful to identify microvascular dysfunction as a precursor of clinically overt coronary disease in this specific risk group.

KW - Chronic kidney disease

KW - Coronary artery disease

KW - Myocardial blood flow

KW - Positron emission tomography

KW - Renal dysfunction

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