Myocardial Perfusion PET for the Detection and Reporting of Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement

Authors

Thomas H. Schindler, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
William F. Fearon, Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
Matthieu Pelletier-Galarneau, Department of Medical Imaging, Montreal Heart Institute, Montréal, Québec, Canada
Giuseppe Ambrosio, University of Perugia School of Medicine Ospedale S. Maria della Misericordia Perugia, Italy
Udo Sechtem, Cardiologicum Stuttgart, Stuttgart, Baden-Wuerttemberg, Germany
Terrence D. Ruddy, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Krishna K. Patel, Icahn School of Medicine at Mount Sinai, Zena, New York, New York, USA
Deepak L. Bhatt, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
Timothy M. Bateman, Saint-Lukes Health System and the Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
Henry Gewirtz, Cardiac Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Jamshid Shirani, Cardiology, St Luke’s University Health Network, Bethlehem, Pennsylvania, USA
Juhani Knuuti, Heart Center, Turku University Hospital, Turku, Finland
Robert J. Gropler, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
Panithaya Chareonthaitawee, Mayo Clinic, Rochester, Minnesota, USA
Riemer H.J.A. Slart, Medical Imaging Center, Departments of Radiology and Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Stephan W. Windecker, University Hospital Bern, Bern, Switzerland
Philipp Antonio Kaufmann, UniversitatsSpital Zurich, Zurich, Switzerland
Maria Roselle Abraham, University of California, San Francisco, San Francisco, United States
Viviany R. Taqueti, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Thomas J. Ford, The University of Newcastle, Faculty of Medicine, Newcastle, Australia
Vasken Dilsizian, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA

Document Type

Article

Abstract

Angina pectoris and dyspnea in patients with normal or nonobstructive coronary vessels remains a diagnostic challenge. Invasive coronary angiography may identify up to 60% of patients with nonobstructive coronary artery disease (CAD), of whom nearly two-thirds may, in fact, have coronary microvascular dysfunction (CMD) that may account for their symptoms. Positron emission tomography (PET) determined absolute quantitative myocardial blood flow (MBF) at rest and during hyperemic vasodilation with subsequent derivation of myocardial flow reserve (MFR) affords the noninvasive detection and delineation of CMD. Individualized or intensified medical therapies with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin II type 1-receptor blockers, beta-blockers, ivabradine, or ranolazine may improve symptoms, quality of life, and outcome in these patients. Standardized diagnosis and reporting criteria for ischemic symptoms caused by CMD are critical for optimized and individualized treatment decisions in such patients. In this respect, it was proposed by the cardiovascular council leadership of the Society of Nuclear Medicine and Molecular Imaging to convene thoughtful leaders from around the world to serve as an independent expert panel to develop standardized diagnosis, nomenclature and nosology, and cardiac PET reporting criteria for CMD. This consensus document aims to provide an overview of the pathophysiology and clinical evidence of CMD, its invasive and noninvasive assessment, standardization of PET-determined MBFs and MFR into “classical” (predominantly related to hyperemic MBFs) and “endogen” (predominantly related to resting MBF) normal coronary microvascular function or CMD that may be critical for diagnosis of microvascular angina, subsequent patient care, and outcome of clinical CMD trials.

First Page

536

Last Page

548

DOI

10.1016/j.jcmg.2022.12.015

Publication Date

4-1-2023

Recommended Citation

Schindler TH, Fearon WF, Pelletier-Galarneau M, Ambrosio G, Sechtem U, Ruddy TD, Patel KK, Bhatt DL, Bateman TM, Gewirtz H, Shirani J. Myocardial perfusion PET for the detection and reporting of coronary microvascular dysfunction: a JACC: cardiovascular imaging expert panel statement. Cardiovascular Imaging. 2023 Apr 1;16(4):536-48.