Left ventricular diastolic inflow and myocardial flow reserve in patients with coronary artery disease: simultaneous analysis of 4D-Flow and myocardial perfusion using hybrid PETMR.
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Abstract
Purpose: This study aimed to simultaneously evaluate the association between diastolic left ventricular (LV) inflow and myocardial flow reserve (MFR) using a hybrid PET/MR system in patients with coronary artery disease (CAD).
Methods: Sixty-seven patients (mean 66 ± 15 years, male 55) with CAD who underwent rest-pharmacological stress 13N-ammonia PET/MR were included. MFR, perfusion defect, and peak filling rate (PFR) were obtained through rest-stress PET. MR acquisition was performed simultaneously during the PET scan to obtain rest-stress 4D flow. Diastolic LV inflow volume (LVinf)(mL/s), peak velocity (peakV)(cm/s), and the change from the rest scan (Δvalue) were computed. Diastolic LV inflow parameters were compared based on the presence or absence of preserved MFR and perfusion defects.
Results: In all patients, diastolic LV inflow parameters significantly increased in the stress scan compared to the rest (53.7 ± 23.1 vs. 64.1 ± 32.9 ml/s, p = 0.0002; 68.1 ± 15.1 vs. 76.4 ± 20.6 cm/s, p = 0.0001 for LVinf and peakV, respectively). PeakV and PFR showed a significant correlation for rest and stress (r = 0.4, p = 0.01; r = 0.3, p = 0.03 for rest and stress, respectively).ΔpeakV significantly correlated to stress MBF, and MFR (r = 0.3, p = 0.007; r = 0.3, p = 0.04 for stress MBF, and MFR, respectively). Among patients with preserved LVEF (n = 47), when were divided into 4 subgroups based on the median myocardial flow reserve (MFR, 1.86) and the presence of perfusion defect, ΔpeakV was significantly higher in those with MFR above median and without abnormal perfusion compared to the other groups (21.8 ± 13.6 vs. 13.5 ± 17.0, 13.0 ± 13.5, and 4.6 ± 19.1; p = 0.04, 0.04, and 0.04 for MFR ≥ 1.86 or < 1.86 with or without abnormal perfusion, respectively).
Conclusion: Non-invasive assessment of diastolic intra-LV hemodynamics derived from 4D flow MR demonstrated a significant association with coronary vasodilation.
目的：本研究旨在利用PET/MR混合系统同时评估冠状动脉疾病（CAD）患者舒张期左心室（LV）流入与心肌血流储备（MFR）之间的关系。方法：67例冠心病患者（平均66±15岁，男性55例）接受休息-药物应激13n -氨PET/MR。静应力PET检测MFR、灌注缺损、峰值充盈率（PFR）。在PET扫描期间同时进行MR采集以获得静应力4D流。计算舒张期左室流入量（LVinf）（mL/s）、峰值流速（peakV）（cm/s）和其余扫描变化（Δvalue）。根据保留MFR和灌注缺损的存在与否比较左室舒张期流入参数。结果：所有患者在应激扫描时左室舒张期血流参数均较其他患者显著升高(53.7±23.1 vs. 64.1±32.9 ml/s, p = 0.0002；LVinf和peakV分别为68.1±15.1 vs. 76.4±20.6 cm/s, p = 0.0001)。PeakV和PFR与休息和应激有显著相关性(r = 0.4, p = 0.01；休息和应激R = 0.3, p = 0.03)。ΔpeakV与应激MBF、MFR显著相关(r = 0.3, p = 0.007；应力MBF和MFR分别为r = 0.3, p = 0.04)。在保留LVEF的患者（n = 47）中，根据中位心肌血流储备（MFR, 1.86）和是否存在灌注缺陷分为4个亚组，MFR高于中位且无灌注异常的患者ΔpeakV显著高于其他组(21.8±13.6 vs 13.5±17.0,13.0±13.5,4.6±19.1；结论：4D血流MR无创评估舒张期左室血流动力学与冠状动脉血管舒张有显著相关性。
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