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Maruo A, Magota K, Munakata Y, Hirata K, Katoh C. Improvement in the estimation of perfusable tissue fraction and myocardial flow reserve in the ischemic myocardial lesions using ECG-gated dynamic myocardial PET with 15O-water. Ann Nucl Med 2024; 38:369-381. [PMID: 38480675 DOI: 10.1007/s12149-024-01913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/15/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Perfusable tissue fraction (PTF) and myocardial flow reserve (MFR) from 15O-water dynamic positron emission tomography (PET) are parameters of myocardial viability. However, myocardial motion causes errors in these values. We aimed to develop accurate estimation of PTF and MFR in ischemic lesions using an electro-cardiogram (ECG)-gated dynamic myocardial PET with 15O-water. METHODS Twenty-seven patients with ischemic heart disease were enrolled. All patients underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). List mode 3D PET data and ECG signals were acquired using Philips Gemini TF64 instrument. For each scan, 500 MBq of 15O-water was infused slowly for 2 min, and the dynamic data were scanned for 6 min. Both non-gated dynamic images and ECG-gated diastolic dynamic images were reconstructed. On the myocardial PET images of each patient, the entire myocardial region of interest (ROI) was set and divided into 17 segments. Myocardial blood flow in the resting state (rest MBF), hyperemic state (stress MBF), PTF, and MFR in each segment were estimated from both non-gated and ECG-gated dynamic PET images. Coronary arteriograms were obtained for all patients. In total, 128 normal segments without stenosis and 50 ischemic segments with > 90% stenosis were evaluated. RESULTS In the ischemic myocardial segments, the PTF with ECG-gated PET was estimated as significantly lower than that with non-gated PET (0.63 ± 0.09 vs. 0.72 ± 0.08 [mL/mL], p < 0.001). The ECG-gated PET estimated a significantly lower PTF in the ischemic segments than in the normal segments (0.63 ± 0.09 vs. 0.67 ± 0.07 [mL/mL], p < 0.01). In the normal segments, the ECG-gated PET detected no significant difference in MFR compared with those from the non-gated PET (2.15 ± 0.76 vs. 2.24 ± 0.79, p = 0.28). However, in the ischemic myocardial segments, the MFR with ECG-gated PET was estimated as significantly lower than that with the non-gated PET (1.23 ± 0.29 vs. 1.69 ± 0.71, p < 0.001). The ECG-gated PET presented a significantly higher inter-observer reproducibility of PTF and rest MBF than the non-gated PET (p < 0.01). Neither stress MBF nor MFR yielded significant differences in inter-observer reproducibility between the ECG-gated and non-gated PET. CONCLUSIONS The ECG-gated dynamic 15O-water PET suppressed the myocardial motion effect and resulted in a lower PTF and MFR in ischemic myocardial lesions than the non-gated PET. The ECG-gated PET seemed to be better than the conventional non-gated dynamic PET for the detection of ischemic myocardial lesion.
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Affiliation(s)
- Ayaka Maruo
- Graduate School of Biomedical Science and Engineering, Hokkaido University, N15, W7 Kita-Ku, Sapporo, 060-8638, Japan.
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, N12, W5 Kita-Ku, Sapporo, 060-8612, Japan.
| | - Keiichi Magota
- Department of Radiology, Hokkaido University Hospital, N14, W5 Kita-Ku, Sapporo, 060-8648, Japan
| | - Yamato Munakata
- Department of Radiology, Hokkaido University Hospital, N14, W5 Kita-Ku, Sapporo, 060-8648, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15, W7 Kita-Ku, Sapporo, 060-8638, Japan
| | - Chietsugu Katoh
- Graduate School of Biomedical Science and Engineering, Hokkaido University, N15, W7 Kita-Ku, Sapporo, 060-8638, Japan
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, N12, W5 Kita-Ku, Sapporo, 060-8612, Japan
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Danad I, Driessen RS. Utility of 82Rb and [ 15O]H 2O PET myocardial perfusion imaging in challenging (high risk) patients: "Don't throw the baby out with the bathwater". J Nucl Cardiol 2024; 32:101783. [PMID: 38233322 DOI: 10.1016/j.nuclcard.2023.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Roel S Driessen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Slart RHJA, Martinez-Lucio TS, Boersma HH, Borra RH, Cornelissen B, Dierckx RAJO, Dobrolinska M, Doorduin J, Erba PA, Glaudemans AWJM, Giacobbo BL, Luurtsema G, Noordzij W, van Sluis J, Tsoumpas C, Lammertsma AA. [ 15O]H 2O PET: Potential or Essential for Molecular Imaging? Semin Nucl Med 2023:S0001-2998(23)00070-3. [PMID: 37640631 DOI: 10.1053/j.semnuclmed.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
Imaging water pathways in the human body provides an excellent way of measuring accurately the blood flow directed to different organs. This makes it a powerful diagnostic tool for a wide range of diseases that are related to perfusion and oxygenation. Although water PET has a long history, its true potential has not made it into regular clinical practice. The article highlights the potential of water PET in molecular imaging and suggests its prospective role in becoming an essential tool for the 21st century precision medicine in different domains ranging from preclinical to clinical research and practice. The recent technical advances in high-sensitivity PET imaging can play a key accelerating role in empowering this technique, though there are still several challenges to overcome.
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Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| | - T Samara Martinez-Lucio
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrikus H Boersma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald H Borra
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Cornelissen
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Magdalena Dobrolinska
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paola A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bruno Lima Giacobbo
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gert Luurtsema
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joyce van Sluis
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charalampos Tsoumpas
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Nordström J, Lindström E, Kero T, Sörensen J, Lubberink M. Influence of image reconstruction on quantitative cardiac 15O-water positron emission tomography. J Nucl Cardiol 2023; 30:716-725. [PMID: 35927378 PMCID: PMC10126040 DOI: 10.1007/s12350-022-03075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The impact on quantitative 15O-water PET/CT of a wide range of different reconstruction settings, including regularized reconstruction by block-sequential regularized expectation maximization (BSREM), was investigated. METHODS Twenty clinical stress scans from patients referred for assessment of myocardial ischemia were included. Patients underwent a 4-min dynamic stress PET scan with 15O-water on a digital PET/CT scanner. Twenty-two reconstructions were generated from each scan and a clinical reconstruction was used as reference. Varied parameters were number of iterations, filter, exclusion of time-of-flight and point-spread function, and regularization parameter with BSREM. Analyses were performed in aQuant utilizing two different methods and resulting regional myocardial blood flow (MBF), perfusable tissue fraction (PTF), and transmural MBF (MBFt) values were evaluated. RESULTS Across the two analyses, correlations toward the reference reconstruction were strong for all parameters (ρ ≥ 0.83). Using automated analysis and the diagnostic threshold of hyperemic MBF at 2.3 mL⋅g-1⋅min-1, diagnosis was unchanged irrespective of reconstruction method in all patients except for one, where only four of the most extreme reconstruction methods resulted in a change of diagnosis. CONCLUSION The low sensitivity of MBF values to reconstruction method and, as previously shown, scanner type and PET/CT misalignment, confirms that diagnostic hyperemic MBF cutoff values can be consistently used for 15O-water.
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Affiliation(s)
- Jonny Nordström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala/Gävleborg County, Gävle, Sweden
| | - Elin Lindström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Medical Physics, Uppsala University Hospital, 75185, Uppsala, Sweden.
| | - Tanja Kero
- PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, 75185, Uppsala, Sweden
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Grönman M, Tarkia M, Stark C, Vähäsilta T, Kiviniemi T, Lubberink M, Halonen P, Kuivanen A, Saunavaara V, Tolvanen T, Teuho J, Teräs M, Savunen T, Pietilä M, Ylä-Herttuala S, Roivainen A, Knuuti J, Saraste A. Assessment of myocardial viability with [ 15O]water PET: A validation study in experimental myocardial infarction. J Nucl Cardiol 2021; 28:1271-1280. [PMID: 31317328 PMCID: PMC8421281 DOI: 10.1007/s12350-019-01818-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Assessment of myocardial viability is often needed in patients with chest pain and reduced ejection fraction. We evaluated the performance of reduced resting MBF, perfusable tissue fraction (PTF), and perfusable tissue index (PTI) in the assessment of myocardial viability in a pig model of myocardial infarction (MI). METHODS AND RESULTS Pigs underwent resting [15O]water PET perfusion study 12 weeks after surgical (n = 16) or 2 weeks after catheter-based (n = 4) occlusion of the proximal left anterior descending coronary artery. MBF, PTF, and PTI were compared with volume fraction of MI in matched segments as assessed by triphenyl tetrazolium chloride staining of LV slices. MBF and PTF were lower in infarcted than non-infarcted segments. Segmental analysis of MBF showed similar area under the curve (AUC) of 0.85, 0.86, and 0.90 with relative MBF, PTF, and PTI for the detection of viable myocardium defined as infarct volume fraction of < 75%. Cut-off values of relative MBF of ≥ 67% and PTF of ≥ 66% resulted in accuracies of 90% and 81%, respectively. CONCLUSIONS Our results indicate that resting MBF, PTF, and PTI based on [15O]water PET perfusion imaging are useful for the assessment of myocardial viability.
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Affiliation(s)
- Maria Grönman
- Turku PET Centre, University of Turku, Turku, Finland
| | - Miikka Tarkia
- Turku PET Centre, University of Turku, Turku, Finland
| | - Christoffer Stark
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Tommi Vähäsilta
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Lubberink
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Virva Saunavaara
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Mika Teräs
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Timo Savunen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mikko Pietilä
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Institute of Clinical Medicine, University of Turku, Turku, Finland
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Abstract
Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.
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Timmer SAJ, Teunissen PFA, Danad I, Robbers LFHJ, Raijmakers PGHM, Nijveldt R, van Rossum AC, Lammertsma AA, van Royen N, Knaapen P. In vivo assessment of myocardial viability after acute myocardial infarction: A head-to-head comparison of the perfusable tissue index by PET and delayed contrast-enhanced CMR. J Nucl Cardiol 2017; 24:657-667. [PMID: 26843199 PMCID: PMC5413541 DOI: 10.1007/s12350-015-0329-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early recognition of viable myocardium after acute myocardial infarction (AMI) is of clinical relevance, since affected segments have the potential of functional recovery. Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viable myocardium. An alternative parameter for detecting viability is the perfusable tissue index (PTI), derived using [15O]H2O positron emission tomography (PET), which is inversely related to the extent of myocardial scar (non-perfusable tissue). The aim of the present study was to investigate the predictive value of PTI on recovery of LV function as compared to DCE-CMR in patients with AMI, after successful percutaneous coronary intervention (PCI). METHODS Thirty-eight patients with ST elevation myocardial infarction (STEMI) successfully treated by PCI were prospectively recruited. Subjects were examined 1 week and 3 months (mean follow-up time: 97 ± 10 days) after AMI using [15O]H2O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening ≥3.0 mm at follow-up by use of CMR. A total of 588 segments were available for serial analysis. RESULTS At baseline, 180 segments were dysfunctional and exhibited DCE. Seventy-three (41%) of these dysfunctional segments showed full recovery during follow-up (viable), whereas 107 (59%) segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 ± 0.09 and was significantly higher compared to nonviable segments (0.80 ± 0.13, P < .001). The optimal cut-off value for PTI was ≥0.85 with a sensitivity of 85% and specificity of 72%, and an area under the curve (AUC) of 0.82. In comparison, a cut-off value of <32% for the extent of DCE resulted in a sensitivity of 72% and a specificity of 69%, and an AUC of 0.75 (AUC PTI vs DCE P = .14). CONCLUSION Assessment of myocardial viability shortly after reperfused AMI is feasible using PET. PET-derived PTI yields a good predictive value for the recovery of LV function in PCI-treated STEMI patients, in excellent agreement with DCE-CMR.
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Affiliation(s)
- Stefan A. J. Timmer
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Paul F. A. Teunissen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Lourens F. H. J. Robbers
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Adriaan A. Lammertsma
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
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de Haan S, Rijnierse MT, Harms HJ, Verberne HJ, Lammertsma AA, Huisman MC, Windhorst AD, van Rossum AC, Allaart CP, Knaapen P. Myocardial denervation coincides with scar heterogeneity in ischemic cardiomyopathy: A PET and CMR study. J Nucl Cardiol 2016; 23:1480-1488. [PMID: 26553060 DOI: 10.1007/s12350-015-0316-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/12/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Mismatch between myocardial innervation and perfusion assessed with positron emission tomography (PET) is a potential risk marker for ventricular arrhythmias in patients with ischemic cardiomyopathy. This mismatch zone originates from residual viable myocardium that has sustained ischemic nerve injury. Heterogenic scar size assessed with late gadolinium-enhanced (LGE) cardiac magnetic resonance imaging (CMR) is also a risk marker of ventricular arrhythmias. These two imaging parameters may represent identical morphological tissue features. The current study explored the relation between innervation-perfusion mismatch and heterogenic scar size. METHODS Twenty-eight patients (26 males, age 67 ± 8 years) with ischemic cardiomyopathy and a left ventricular ejection fraction below 35%, eligible for ICD implantation were included. All patients underwent both [11C]-hydroxyephedrine and [15O]-water PET studies to assess myocardial sympathetic innervation and perfusion. LGE CMR was conducted to assess total myocardial scar size, scar core size, and heterogenic scar size. RESULTS Perfusion defect size was 16.6 ± 9.9% and innervation defect size was 33.7 ± 10.8%, which resulted in an innervation-perfusion mismatch of 17.6 ± 8.9%. Total scar size, scar core size, and heterogenic scar size were 21.2 ± 8.6%, 14.7 ± 6.6%, and 6.5 ± 2.9%, respectively. No relation between scar core size and perfusion deficit size was observed (r = 0.18, P = .36). Total scar size was correlated with the innervation defect size (r = 0.52, P = .004) and the heterogenic scar zone displayed a significant correlation with the innervation-perfusion mismatch area (r = 0.67, P < .001). CONCLUSIONS Denerved residual viable myocardium in ischemic cardiomyopathy as observed with innervation-perfusion PET is related to the heterogenic scar zone as assessed with LGE CMR.
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Affiliation(s)
- Stefan de Haan
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Mischa T Rijnierse
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Hendrik J Harms
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc C Huisman
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Recent results from prospective randomized controlled trials examining the management of patients with ischemic cardiomyopathy (ICM) have questioned both the added value of revascularization over contemporary optimal medical therapy (OMT) and the use of viability testing as a gate-keeper to revascularization. The purpose of this review is to summarize recent trial evidence before discussing future perspectives in the field. RECENT FINDINGS The Surgical Treatment of Ischemic Heart Failure (STICH) trial, PPAR-2 trial and Heart Failure Revascularisation Trial have all reported their results within the past 5 years. None of these trials found revascularization superior to OMT in improving survival of ICM patients. Additionally, the STICH trial's viability substudy suggested that pretreatment viability testing was not beneficial. SUMMARY ICM patients remain a clinical conundrum. The numerous limitations of the recent RCTs have led to uncertainty about optimal management. Revascularization continues to be offered to patients with evidence of myocardial viability. Further studies are required to answer the outstanding questions in the management of patients with ICM.
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Stegger L, Schülke C, Wenning C, Rahbar K, Kies P, Schober O, Schäfers M. Cardiac PET/MRI. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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F-18 fluorodeoxyglucose uptake and water-perfusable tissue fraction in assessment of myocardial viability. Ann Nucl Med 2012; 26:644-55. [PMID: 22797841 PMCID: PMC3475968 DOI: 10.1007/s12149-012-0631-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 06/18/2012] [Indexed: 11/27/2022]
Abstract
Objectives 15O-water-perfusable tissue fraction (PTF) has been shown to be a potential index for assessing myocardial viability in PET, an alternative to 18F-fluorodeoxyglucose (FDG). This study aimed to directly compare these two independent methods in assessing myocardial viability in patients with abnormal wall motion. Methods PET study was performed on 16 patients with previous myocardial infarction, before coronary artery bypass graft operation (CABG). The protocol included a 15O-carbonmonoxide static, a 15O-water dynamic and an 18F-FDG dynamic scan, during the euglycemic hyperinsulinemic clamp. Echocardiography was performed at the time of PET and 5–12 months after the CABG, and the wall motion recovery was evaluated on segmental and global bases. Consistency between PTF and 18F-FDG was evaluated visually and also in a quantitative manner. Predictive values for the wall motion recovery were also compared between the two approaches. Results The image quality of 18F-FDG was superior to that of 15O-water. The qualitative PTF showed significantly smaller defects than 18F-FDG, and the quantitative PTF showed slightly greater values than 18F-FDG in the infarcted region. The two methods were, however, consistent visually and also quantitatively. The predictive values of the wall motion recovery were almost equal between the two approaches. The absolute 18F-FDG uptake was varied in normal segments, and predictive values for the wall motion recovery by the absolute 18F-FDG was less (accuracy: 80 %) compared with those by the relative 18F-FDG (accuracy: 87 %) and the quantitative PTF (accuracy: 89 %). Conclusion Despite the small sample size, PTF appears to give consistent results with the 18F-FDG approach, and might be an alternative viability assessment.
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