長尾　充展    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Associate Professor
Language	English
Title	Papillary Muscle Ischemia and Global Myocardial Flow Reserve in Coronary Artery Disease: Assessment by High-resolution Cine Imaging of 13Nammonia PET
Conference	The 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS2019)
Promoters	Japanese Circulation Society
Conference Type	Nationwide Conferences
Presentation Type	Speech
Lecture Type	General
Publisher and common publisher	◎NAKAO Risako, NAGAO Michinobu, MOMOSE Mitsuru, KASUGA Noriko, MATSUO Yuka, WATANABE Eri, SAKAI Akiko, HAGIWARA Nobuhisa
Date	2019/03/30
Venue (city and name of the country)	Yokohama, JAPAN
Summary	*Oral Presentation (English) 24 Nuclear Imaging Purpose: Papillary muscle perfusion is supply from microvessels of peripheral coronary arteries, and is susceptible the elevation of vascular resistance. Papillary muscle ischemia (PMI) is caused by micro-vessels´ occlusion in the broad endocardium. However, the clinical significant is not understood because PMI could not be detected by existing perfusion imaging such as SPECT and MRI. We propose the detection method of PMI using 13N-ammonia PET (NH3-PET), and investigate the effect to the global myocardial flow reserve (Global-MFR) in coronary artery disease (CAD).Methods: Data of adenosine-stress NH3-PET for 46 patients with significant coronary stenosis was analyzed. Using high-resolution cine imaging of NH3-PET, PMI was defined as the absence of the PM accumulation at stress conditions. Myocardial flow was generated from the time activity curve of left ventricle input and myocardial uptake using 3-compartment model and the first 2 minutes ´ dataset of list mode images. Global-MFR was calculated by stress to rest flow ratio. Summed stress score (SSS) was used as an estimate of the extent of ischemia.Results: PMI was seen in 17 of 46 patients with CAD (37%). Global-MFR was significantly lower for patients with PMI than those without (1.6 ± 0.6 vs. 2.0 ± 0.5, p<0.05). There was no difference in SSS and culprit coronary territories between patients with and without PMI (SSS, 19.2 ± 7.1 vs. 19.4 ± 7.6).Conclusion: NH3-PET allows to detect PMI in about one third patients with CAD regardless of the extent of ischemia. The presence of PMI is an important sign for reduced Global-MFR, suggesting the broad microvascular injury.