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28.09.2016 | Original Article | Ausgabe 3/2018 Open Access

Journal of Nuclear Cardiology 3/2018

Stress myocardial blood flow correlates with ventricular function and synchrony better than myocardial perfusion reserve: A Nitrogen-13 ammonia PET study

Journal of Nuclear Cardiology > Ausgabe 3/2018
MD Luis Eduardo Juárez-Orozco, MD Erick Alexanderson, MD, PhD Rudi A. Dierckx, PharmD, PhD Hendrikus H. Boersma, MD, PhD Johannes L. Hillege, MD, PhD Clark J. Zeebregts, MD Myriam M. Martínez-Aguilar, MD Antonio Jordán-Ríos, MD Ana Gabriela Ayala-German, MD, PhD Niek Prakken, MD, PhD Rene A. Tio, MD, PhD Riemer H. Slart
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s12350-016-0669-y) contains supplementary material, which is available to authorized users.
See related editorial, doi:10.​1007/​s12350-016-0696-8.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.​com.



Cardiac PET quantifies stress myocardial blood flow (MBF) and perfusion reserve (MPR), while ECG-gated datasets can measure components of ventricular function simultaneously. Stress MBF seems to outperform MPR in the detection of significant CAD. However, it is uncertain which perfusion measurement is more related to ventricular function. We hypothesized that stress MBF correlates with ventricular function better than MPR in patients studied for suspected myocardial ischemia.


We studied 248 patients referred to a rest and adenosine-stress Nitrogen-13 ammonia PET. We performed a multivariate analysis using systolic function (left ventricular ejection fraction, LVEF), diastolic function (mean filling rate in diastole, MFR/3), and synchrony (Entropy) as the outcome variables, and stress MBF, MPR, and relevant covariates as the predictors. Secondarily, we repeated the analysis for the subgroup of patients with and without a previous myocardial infarction (MI).


166 male and 82 female patients (mean age 63 ± 11 and 67 ± 11 year, respectively) were included. 60% of the patients presented hypertension, 57% dyslipidemia, 21% type 2 diabetes mellitus, 45% smoking, and 34.7% a previous MI. Mean stress MBF was 1.99 ± 0.75 mL/g/min, MPR = 2.55 ± 0.89, LVEF = 61.6 ± 15%, MFR/3 = 1.12 ± 0.38 EDV/s, and Entropy = 45.6 ± 11.3%. There was a significant correlation between stress MBF (P < .001) and ventricular function. This was stronger than the one for MPR (P = .063). Sex, age, diabetes, and extent of previous MI were also significant predictors. Results were similar for the analyses of the 2 subgroups.


Stress MBF is better correlated with ventricular function than MPR, as evaluated by Nitrogen-13 ammonia PET, independently from other relevant cardiovascular risk factors and clinical covariates. This relationship between coronary vasodilatory capacity and ventricular function is sustained across groups with and without a previous MI.

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