Role of quantitative and gated myocardial perfusion PET imaging

The aim of this thesis is to expand our understanding of quantitative myocardial perfusion and ventricular synchrony measured by 13N-ammonia Positron Emission Tomography (PET). This thesis starts with a brief description of the production, pharmacokinetic parameters and imaging protocol of 13N-ammonia. Furthermore, it outlines the current clinical role of myocardial perfusion imaging with PET. With regard to the clinical use of quantitative myocardial perfusion, this thesis focuses on the diagnostic and prognostic value of PET. This thesis reports that myocardial bridging, which refers to a band of myocardium overlying a segment of a coronary artery, is related to low flow reserve measured by PET and that patients with chest pain and normal coronary arteries with low perfusion quantification had an increased risk for cardiovascular events. Moreover, it describes the technical principles on the use of PET for mechanical synchrony. Special attention is given to the detection of myocardial stunning and ischemia induced dyssynchrony for the assessment of coronary artery disease and selection of patients with heart failure that may benefit of cardiac resynchronization therapy. This thesis concludes that even though PET has gained popularity for the assessment of coronary artery disease, progress still needs to be made to standardize protocols and to understand other potential clinical applications, such as the assessment of vasodilator capacity as a marker of cardiovascular risk or the assessment of mechanical synchrony in patients with heart failure.