PET-based assessment of coronary microvascular dysfunction and its relation to plaque burden and vascular remodeling: integration with microvascular resistance reserve.

Authors

Yipu Ding, Roel Hoek, Putri Annisa Kamila, Ibrahim Danad, Nick S Nurmohamed, Ruurt A Jukema, Pieter G Raijmakers, Roel S Driessen, Pepijn A van Diemen, Andrew D Choi, Juhani Knuuti, Paul Knaapen, Hongbin Liu, Jeroen J Bax, Alexander van Rosendael, on the behalf of the PACIFIC-1 Investigators.

Published in

European journal of nuclear medicine and molecular imaging. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Coronary microvascular dysfunction (CMD) contributes to myocardial ischemia in patients with angina and non-obstructive coronary artery disease. Quantitative positron emission tomography (PET) allows noninvasive assessment of myocardial blood flow and identification of CMD.
To investigate the association between PET-assessed coronary microvascular dysfunction (CMD), coronary plaque burden, and vascular remodeling, integrating microvascular resistance reserve (MRR).
This post hoc analysis of the PACIFIC-1 trial included coronary arteries from symptomatic patients with suspected stable CAD who underwent [¹⁵O]water PET, coronary CT angiography (CTA), and invasive fractional flow reserve (FFR). Coronary arteries were categorized into three groups: non-ischemic vessels (normal FFR and hyperemic myocardial blood flow [hMBF], n = 352), CMD vessels (normal FFR but impaired hMBF, n = 88), and epicardial flow-limiting vessels (abnormal FFR, n = 159). MRR was calculated by integrating PET-derived coronary flow reserve with invasive FFR. AI-based CTA quantified plaque burden and remodeling.
Diameter stenosis and plaque burden increased progressively from non-ischemic to CMD to epicardial flow-limiting vessels (all P < 0.05). CMD vessels demonstrated the largest lumen volume (583.75 mm³ [IQR 337.02-754.30]) and lumen area (4.63 mm² [IQR 3.77-6.67]) among the three groups (both P < 0.05). In non-ischemic vessels, noncalcified plaque burden was associated with worse microvascular function detected by MRR (B = -0.12, 95%CI [-0.21, -0.04], P = 0.006). In CMD vessels, remodeling index was independently associated with higher MRR after adjustment (B = 0.10, 95%CI [0.05, 0.15], P < 0.001).
CMD is associated with an intermediate atherosclerotic burden and paradoxical lumen enlargement, representing a distinct functional-structural phenotype defined by PET-derived microvascular dysfunction and CT-based plaque characteristics.
URL: https://www.
gov ; Unique identifier: NCT01521468.

PMID:
42406072
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.