Papillary muscle ischemia and myocardial blood flow on N13-ammonia positron emission tomography myocardial perfusion ima
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Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL Division of Molecular Imaging and Therapeutics, The University of Alabama at Birmingham, Birmingham, AL The University of Alabama in Birmingham, Birmingham, AL
Received Aug 6, 2020; accepted Aug 6, 2020 doi:10.1007/s12350-020-02336-5
See related article https://doi.org/10.100 7/s12350-020-02231-z.
INTRODUCTION The two-left ventricular (LV) papillary muscles (anterolateral and posteromedial) are small structures that are vital to mitral valve competence and LV function. Partial or complete papillary muscle rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, and is associated with increased morbidity and mortality.1 However, despite the clinical significance of papillary muscle (PM) ischemia, the assessment of papillary muscle perfusion has been challenging with cardiac single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) or Magnetic Resonance Imaging. Conventional nuclear imaging techniques like SPECT or gated radionuclide ventriculography lack the depth of spatial resolution in comparison to positron emission tomography (PET) for visualization of different patterns of papillary muscle ischemia.2,3 PM visualization not only helps to diagnose PM ischemia but also differentiate between the various stages of ischemia, ranging from hibernation to infarction, which allows for better management of patients.
Reprint requests: Sudeep Raj Aryal, MD, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL ; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Nakao et al. from Tokyo, Japan, in this issue of the Journal of Nuclear Cardiology (4) describe the role of N13-ammonia PET Myocardial Perfusion Imaging (MPI) in (1) detection of papillary muscle (PM) ischemia and (2) association of PM ischemia with global myocardial flow reserve (MFR) and its prognostic value in coronary artery disease (CAD). The causes of coronary circulatory dysfunction in patients with risk factors for CAD are multifactorial, with a reduction in the bioavailability of endotheliumderived nitric oxide through various mechanisms, the probable common final pathway.5 Endothelial activation plays a pivotal role in the pathogenesis of acute coronary syndromes. It is characterized by coronary plaque vulnerability, and paradoxical vasoconstriction, which likely contributes to plaque rupture.6 Impairment of coronary circulatory function is expected to reflect in part the vulnerability of plaque, which in turn may explain the independent predictive value of coronary circulatory dysfunction for future cardiovascular events.7 It may be concluded that functional alterations of the coronary circulatory function appear to reflect ongoing processes that modify the arterial wall’s functional status. Thus, functional alterations of the coronary circulation appear to be more reliable in the assessme
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