Author + information
- Received January 20, 2011
- Accepted February 4, 2011
- Published online August 1, 2011.
- Colin M. Barker, MD⁎,⁎ (, )
- Nils P. Johnson, MD, MS⁎,†,
- Stefano Sdringola, MD⁎,† and
- K. Lance Gould, MD⁎,†
- ↵⁎Reprint requests and correspondence
: Dr. Colin M. Barker, Division of Cardiology, Department of Medicine, 6341 Fannin Street, MSB 2.146, Houston, Texas 77030
A 62-year-old man with human immunodeficiency virus but no manifest heart disease enrolled in the Century Health Study (1). Cardiac risk factors included hypertension, hyperlipidemia, and prior tobacco use. He exercised for 9 min of a Bruce protocol, stopping due to fatigue, with equivocal ST-segment changes and no angina at 91% of his age-predicted maximal heart rate. Physical examination was unremarkable.
Baseline cardiac positron emission tomography (PET) with absolute flow showed large, severe, stress-induced inferior and septal defects encompassing 51% of the left ventricle (Fig. 1A). Lowest coronary flow reserve (CFR) was 0.4, indicating myocardial steal. The anterior wall was spared due to intact, large diagonal or ramus branches. Gated ejection fraction was 44%.
Coronary angiography confirmed PET images. A dominant left circumflex artery had a mid stenosis and subtotal occlusions proximal to the last obtuse marginal and posterior descending arteries (Fig. 2, top row, green arrows). The mid left anterior descending had a long, severe lesion (Fig. 2, red arrow) just after the first septal (blue arrows) and ramus branches (purple arrows).
Percutaneous coronary intervention (PCI) treated both areas with 6 drug-eluting stents (Fig. 2, middle row). Repeat PET within 30 days after PCI demonstrated marked improvement in noninvasive CFR, with areas of prior steal now showing CFR = 1.8 (Fig. 1B). Gated ejection fraction improved to 77%. Mild, distal diffuse disease was treated medically.
Cardiac PET with quantitative flow for CFR provides a detailed guide to PCI and verifies its outcome. High-quality, noninvasive quantitative PET imaging optimizes patient selection for PCI.
Dr. Barker is on the Speakers' Bureau for Medtronic and Cordis; and is on the advisory board/consultant for Cordis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 20, 2011.
- Accepted February 4, 2011.
- American College of Cardiology Foundation