Prediction of Recovery of Myocardial Dysfunction After Revascularization Comparison of Fluorine-18 Fluorodeoxyglucose/Thallium-201 SPECT, Thallium-201 Stress–Reinjection SPECT and Dobutamine Echocardiography (original) (raw)
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CHEST Journal, 2000
Study objectives: Clinical studies comparing fatty acid and glucose metabolism in relation to functional recovery of ischemic myocardium after coronary revascularization are scarce. This study evaluated the recovery of regional and global left ventricular function after coronary revascularization in relation to uptake patterns of -methyl-iodophenyl-pentadecanoic acid (BMIPP) and fluorodeoxyglucose (FDG) in patients with ischemic myocardial dysfunction. Methods: Patients with ischemic regional wall motion abnormality underwent baseline viability imaging with 18 F-FDG, 123 I-BMIPP, and 99m Tc-methoxyisobutylisonitrile, and the regions with evidence for maintained tissue viability were revascularized. Mismatch of uptake score between two different single-photon emission CT (SPECT) images in the same myocardial region was graded as low or high mismatch. Regional and global left ventricular functional changes after revascularization were analyzed in relation to mismatch severity and difference of total uptake score in each SPECT image pair. A total of 33 vessels in 30 patients related to the asynergic regions were revascularized, and a total of 100 myocardial segments perfused by the revascularized vessels were analyzed. Results: Segments showing high metabolic mismatch (FDG/BMIPP) had lowest regional wall motion score at baseline, representing the most severely impaired ischemic myocardium, and had highest improvement in regional wall motion score after revascularization. Difference of total uptake score between FDG and BMIPP showed a significant positive correlation with difference of ejection fraction between pre-and postrevascularization (r ؍ 0.774, p < 0.0001). Conclusions: Combined metabolic SPECT imaging with FDG and BMIPP has the potential to identify severely impaired ischemic myocardium leading to more efficient therapeutic management of patients with coronary artery disease.
FDG SPECT in the assessment of myocardial viability: Comparison with dobutamine echo
European Heart Journal, 1997
The use of l8 F-fluorodeoxyglucose (FDG) imaging with single photon emission computed tomography (SPECT) has been introduced recently to assess myocardial viability. Several centres have now gained experience with cardiac FDG SPECT imaging, and this report is a summary of the currently available FDG SPECT data. Three studies have compared FDG SPECT with FDG positron emission tomography and demonstrated good agreement between them. Initial results in patients undergoing revascularization suggest that FDG SPECT can predict improvement in contractile function after revascularization. Although the initial results are promising, larger studies are needed to determine the precise role of FDG SPECT in the assessment of myocardial viability. (Eur Heart J 1997; 18 (Suppl D): D124-D129)
2006
Background. Traditionally, cardiac fluorodeoxyglucose (FDG) uptake is combined with regional perfusion for optimal evaluation of viability. Gated FDG-positron emission tomography (PET) may be an alternative technique for detection of viability because it permits combined assessment of glucose metabolism uptake and wall thickening (WT). In this study the value of FDG uptake and WT (analyzed from a stand-alone gated FDG-PET study) for the prediction of recovery of regional and global left ventricular (LV) function in patients with coronary artery disease undergoing revascularization is studied.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2002
201Tl imaging and dobutamine echocardiography (DE) can both identify viable myocardium. Prediction of functional outcome after revascularization remains suboptimal with either technique because of the relatively low specificity of (201)Tl and low sensitivity of DE. This study was undertaken to develop an optimal testing strategy for prediction of post-revascularization functional outcome. Seventy-three patients (mean [+/-SD] left ventricular ejection fraction [LVEF], 32% +/- 8%) underwent DE and resting (201)Tl SPECT (4-h delayed imaging) before surgical revascularization. Dysfunctional segments with (201)Tl activity > or = 50% or with contractile reserve were considered viable. LVEF was assessed before and 3-6 mo after revascularization. Analysis of receiver operator characteristic curves showed that the optimum criteria to predict improvement (> or = 5%) in LVEF after revascularization were > or = 6 viable dysfunctional segments (using a 16-segment model) on (201)Tl and &...
Chest, 2000
Study objectives: Clinical studies comparing fatty acid and glucose metabolism in relation to functional recovery of ischemic myocardium after coronary revascularization are scarce. This study evaluated the recovery of regional and global left ventricular function after coronary revascularization in relation to uptake patterns of -methyl-iodophenyl-pentadecanoic acid (BMIPP) and fluorodeoxyglucose (FDG) in patients with ischemic myocardial dysfunction. Methods: Patients with ischemic regional wall motion abnormality underwent baseline viability imaging with 18 F-FDG, 123 I-BMIPP, and 99m Tc-methoxyisobutylisonitrile, and the regions with evidence for maintained tissue viability were revascularized. Mismatch of uptake score between two different single-photon emission CT (SPECT) images in the same myocardial region was graded as low or high mismatch. Regional and global left ventricular functional changes after revascularization were analyzed in relation to mismatch severity and difference of total uptake score in each SPECT image pair. A total of 33 vessels in 30 patients related to the asynergic regions were revascularized, and a total of 100 myocardial segments perfused by the revascularized vessels were analyzed. Results: Segments showing high metabolic mismatch (FDG/BMIPP) had lowest regional wall motion score at baseline, representing the most severely impaired ischemic myocardium, and had highest improvement in regional wall motion score after revascularization. Difference of total uptake score between FDG and BMIPP showed a significant positive correlation with difference of ejection fraction between pre-and postrevascularization (r ؍ 0.774, p < 0.0001). Conclusions: Combined metabolic SPECT imaging with FDG and BMIPP has the potential to identify severely impaired ischemic myocardium leading to more efficient therapeutic management of patients with coronary artery disease.
Το compare echocardiographic left ventricular (LV) long axis function and single photon emission computed tomography (SPECT) thallium-201 scintigraphy for the prediction of recovery of LV dyssynergies after revascularization. Methods: Thirty patients with a history of previous myocardial infarction and LV dysfunction underwent a transthoracic echocardiographic study before and after successful revascularization (101±14 days), in order to evaluate post-revascularization recovery of asynergic myocardial walls. In these patients and in 25 age-and sex-matched healthy subjects, an additional study during dobutamine infusion was also performed. All subjects also underwent SPECT thallium-201 scintigraphy. Prior and during dobutamine infusion the LV systolic atrioventricular (AV) plane displacement was recorded from the apical four and two chamber views, by M-Mode, at four LV sites, corresponding to the septal, lateral, anterior and inferior walls. Results: Healthy subjects showed a significant increase in AV displacement at all LV sites during dobutamine infusion (p<0.001). However, patients exhibited a significant increase in AV displacement during dobutamine infusion, only in the asynergic sites, with functional improvement in the post-revascularization echocardiogram (p<0.001). In the remaining asynergic sites, the AV displacement did not change (p>0.05). Selecting a maximum LV systolic AV displacement increase of >2 mm, the method proved to have a sensitivity of 91%, specificity of 83%, positive predictive value of 88% and negative predictive value of 87%. When SPECT thallium scans were used, the above indices were 86%, 65%, 74% and 79% respectively. Conclusion: The assessment of LV long axis function with the measurement of left systolic AV plane displacement during dobutamine infusion constitutes a simple and accurate method, better than SPECT thalium images, for the prediction of recovery of LV asynergy after revascularization.