3D PET Myocardial Blood Flow and Rb82 Infusion Profiles

Quantification of Myocardial Blood Flow by 3D Positron Emission Tomography With High and Low Rate Rb82 Infusion Profiles

The investigators seek to test bolus infusions (50ml/min) vs. slow infusions (20 ml/min) of Rb-82 on metrics of coronary blood flow assessed on a modern 3D PET/CT.

As perfusion metrics in the healthy volunteers, patients with risk factors and/or coronary artery disease and in tissue with transmural myocardial infarctions has been well defined AND same day test-retest variability minutes apart using a bolus infusion is ±10%, the investigators shall test 3 hypotheses. The first hypothesis is repeated same day test-retest coefficient of variation (COV) of whole heart rMBF and sMBF acquired using a bolus infusion profile (50 mls/min) on a modern 3D PET scanner falls within ± 10%. The second hypothesis is repeated same day test-retest COV of whole heart rMBF and sMBF acquired using a slow infusion activity profile (20 mls/min) on a modern 3D PET scanner falls within ± 10%. The third hypothesis is COV of whole heart rMBF and sMBF between bolus and slow activity profiles is ± 10% where the bolus is considered the standard on a modern 3D PET scanner.

The investigators will test the different activity profiles on 3 distinct populations:

1. Healthy volunteers
2. Clinical volunteers with risk factors and/or CAD
3. Volunteers with clinical infarcts.

Inclusion Criteria:

Normal Volunteers

• Adults ≥18 and <40 years old able to give informed consent.
• Ability to abstain from caffeine for 48 hours

The "clinical" population

• Adults ≥18 years old able to give informed consent.
• Any cardiac risk factor including hypertension, hyperlipidemia, diabetes mellitus or tobacco use OR
• CAD defined by with history of PCI or CABG, Coronary Ca score>400, or dense coronary calcifications noted on chest CT
• Ability to abstain from caffeine for 48 hours

The "infarct" population

• Adults ≥18 years old able to give informed consent.

• Prior cardiac PET scan demonstrating a fixed defect ≥ 15% of the LV myocardium with relative uptake ≤60% maximum uptake.

• In addition, to the perfusion defect, each volunteer requires either:

  • FDG PET or MRI viability studies confirming infarct OR
  • akinesis and wall thinning on ECHO within the same territory as the PET defect in addition to Q-waves on ECG

• Ability to abstain from caffeine for 48 hours

Exclusion Criteria:

Normal Volunteers

• Any chronic cardiac disease or condition (e.g., hypertension, hyperlipidemia)
• Any chronic systemic disease or condition (e.g., diabetes, systemic lupus, rheumatoid arthritis)
• Tobacco use
• Family history in a first degree relative with clinical CAD (h/o PCI, MI or CABG) in men <55 or women <65
• Severe claustrophobia
• Positive urine pregnancy test
• Inability to give informed consent
• BMI ≥ 30 or BMI>25 and <30 provided waist to hip ratio >0.80 in women or 0.90 in men.

The "clinical" and "infarct" populations

• Severe claustrophobia
• Hemodynamic instability or unstable symptoms
• Positive urine pregnancy test
• Inability to give informed consent