1
|
Luong TV, Ebbehoj A, Kjaerulff MLG, Nielsen R, Nielsen PH, Christiansen EH, Tolbod LP, Søndergaard E, Gormsen LC. Clinical use of cardiac 18 F-FDG viability PET: a retrospective study of 44 patients undergoing post-test revascularization. Int J Cardiovasc Imaging 2022; 38:2447-2458. [DOI: 10.1007/s10554-022-02661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/25/2022] [Indexed: 11/05/2022]
|
2
|
Wang J, Li JM, Li S, Hsu B. Absolute Resting 13N-Ammonia PET Myocardial Blood Flow for Predicting Myocardial Viability and Recovery of Ventricular Function after Coronary Artery Bypass Grafting. J Nucl Cardiol 2022; 29:987-999. [PMID: 33089879 DOI: 10.1007/s12350-020-02388-7] [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: 05/27/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to evaluate the feasibility of resting myocardial blood flow (rMBF), quantified with dynamic 13 N-Ammonia (NH3) PET, for identifying myocardial viability and predicting improvement of left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG). METHODS Ninety-three patients with coronary artery disease (CAD) and chronic LVEF < 45%, scheduled for CABG, had dynamic 13NH3 PET and 18F-FDG PET imaging. The perfusion/metabolism polar maps were categorized in four patterns: normal (N), mismatch (M1), match (M2) and reverse mismatch (RM). The value of rMBF for identifying viable myocardium (M1, RM) and post CABG improvement of LVEF≥8% was analyzed by receiver operating characteristic (ROC) curves. Correlations of rMBF in segments to ΔLVEF post CABG were verified. RESULTS Mean rMBFs were significantly different (N=0.60±0.14; M1=0.44±0.07, M2=0.34±0.08, RM=0.53±0.09 ml/min/g, P<0.001). The optimal rMBF cutoff to identify viable myocardium was 0.42 ml/min/g (sensitivity=88.3%, specificity=82.0%) and 0.43 ml/min/g for predicting improvement of LVEF ≥8% (74.6%, 80.0%). The extent and rMBF of combined M1/RM demonstrated a moderate to high correlation to improved LVEF (r=0.78, 0.71, P<0.001). CONCLUSION Resting MBF, derived by dynamic 13NH3 PET, may be positioned as a supplement to 18F-FDG PET imaging for assessing the presence of viable myocardium and predicting potential improvement of LVEF after CABG.
Collapse
Affiliation(s)
- Jiao Wang
- Teda International Cardiovascular Hospital Nuclear Medicine Department, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, 300457, China
| | - Jian-Ming Li
- Teda International Cardiovascular Hospital Nuclear Medicine Department, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, 300457, China.
| | - Shuai Li
- Teda International Cardiovascular Hospital Nuclear Medicine Department, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, 300457, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
| |
Collapse
|
3
|
Ko KY, Wang SY, Yen RF, Shiau YC, Hsu JC, Tsai HY, Lee CL, Chiu KM, Wu YW. Clinical significance of quantitative assessment of glucose utilization in patients with ischemic cardiomyopathy. J Nucl Cardiol 2020; 27:269-279. [PMID: 30109593 DOI: 10.1007/s12350-018-1395-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to prospectively quantify the rate of myocardial glucose uptake (MRGlu) in myocardium with different perfusion-metabolism patterns and determine its prognostic value in patients with ischemic cardiomyopathy. METHODS AND RESULTS 79 patients with ischemic cardiomyopathy were prospectively enrolled for dynamic cardiac FDG PET, and then followed for at least 6 months. Perfusion-metabolism patterns were determined based on visual score analysis of 201Tl SPECT and FDG PET. MRGlu was analyzed using the Patlak kinetic model. The primary end-point was cardiovascular mortality. Significantly higher MRGlu was observed in viable compared with non-viable areas. Negative correlations were found between MRGlu in transmural match and a history of hyperlipidemia, statin usage, and triglyceride levels. Diabetic patients receiving dipeptidyl peptidase-4 inhibitors (DPP4i) had a significantly lower MRGlu in transmural match, mismatch, and reverse mismatch. Patients with MRGlu in transmural match ≥ 23.40 or reverse mismatch ≥ 36.90 had a worse outcome. CONCLUSIONS Myocardial glucose utilization was influenced by substrates and medications, including statins and DPP4i. MRGlu could discriminate between viable and non-viable myocardium, and MRGlu in transmural match and reverse mismatch may be prognostic predictors of cardiovascular death in patients with ischemic cardiomyopathy.
Collapse
Affiliation(s)
- Kuan-Yin Ko
- Department of Nuclear Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin County, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hao-Yuan Tsai
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Lin Lee
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei, Taiwan.
| |
Collapse
|
4
|
Bois JP, Chareonthaitawee P. Radionuclide Imaging in Congestive Heart Failure: Assessment of Viability, Sarcoidosis, and Amyloidosis. Cardiol Clin 2015; 34:119-32. [PMID: 26590784 DOI: 10.1016/j.ccl.2015.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radionuclide imaging provides both established and emerging diagnostic and prognostic tools to assist clinicians in the management of patients with ischemic cardiomyopathy, cardiac sarcoidosis, and cardiac amyloidosis. This review highlights the underlying pathophysiology of each entity and associated diagnostic and clinical challenges, and describes the available radionuclide imaging techniques. Specific protocols, advantages and disadvantages, comparison with other noninvasive imaging modalities, and discussion of the evolving role of hybrid imaging are also included.
Collapse
Affiliation(s)
- John P Bois
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | | |
Collapse
|
5
|
McCrary JR, Wann LS, Thompson RC. PET imaging with FDG to guide revascularization in patients with systolic heart failure. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
6
|
Zhang X, Schindler TH, Prior JO, Sayre J, Dahlbom M, Huang SC, Schelbert HR. Blood flow, flow reserve, and glucose utilization in viable and nonviable myocardium in patients with ischemic cardiomyopathy. Eur J Nucl Med Mol Imaging 2013; 40:532-41. [PMID: 23287994 DOI: 10.1007/s00259-012-2311-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/21/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to determine whether glucose uptake in viable myocardium of ischemic cardiomyopathy patients depends on rest myocardial blood flow (MBF) and the residual myocardial flow reserve (MFR). METHODS Thirty-six patients with ischemic cardiomyopathy (left ventricular ejection fraction 25 ± 10 %) were studied with (13)N-ammonia and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Twenty age-matched normals served as controls. Regional MBF was determined at rest and during dipyridamole hyperemia and regional FDG extraction was estimated from regional FDG to (13)N-ammonia activity ratios. RESULTS Rest MBF was reduced in viable (0.42 ± 0.18 ml/min per g) and nonviable regions (0.32 ± 0.09 ml/min per g) relative to remote regions (0.68 ± 0.23 ml/min per g, p < 0.001) and to normals (0.63 ± 0.13 ml/min per g). Dipyridamole raised MBFs in controls, remote, viable, and nonviable regions. MBFs at rest (p < 0.05) and stress (p < 0.05) in viable regions were significantly higher than that in nonviable regions, while MFRs did not differ significantly (p > 0.05). Compared to MFR in remote myocardium, MFRs in viable regions were similar (1.39 ± 0.56 vs 1.70 ± 0.45, p > 0.05) but were significantly lower in nonviable regions (1.23 ± 0.43, p < 0.001). Moreover, the FDG and thus glucose extraction was higher in viable than in remote (1.40 ± 0.14 vs 0.90 ± 0.20, p < 0.001) and in nonviable regions (1.13 ± 0.21, p < 0.001). The extraction of FDG in viable regions was independent of rest MBF but correlated inversely with MFRs (r =-0.424, p < 0.05). No correlation between the FDG extraction and MFR was observed in nonviable regions. CONCLUSION As in the animal model, decreasing MFRs in viable myocardium are associated with increasing glucose extraction that likely reflects a metabolic adaptation of remodeling hibernating myocytes.
Collapse
Affiliation(s)
- Xiaoli Zhang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-6948, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Takalkar A, Agarwal A, Adams S, Alavi A, Torigian DA. Cardiac Assessment with PET. PET Clin 2011; 6:313-26. [DOI: 10.1016/j.cpet.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Yoon MH, Tahk SJ, Yang HM, Woo SI, Lim HS, Kang SJ, Choi BJ, Choi SY, Hwang GS, Shin JH. Comparison of accuracy in the prediction of left ventricular wall motion changes between invasively assessed microvascular integrity indexes and fluorine-18 fluorodeoxyglucose positron emission tomography in patients with ST-elevation myocardial infarction. Am J Cardiol 2008; 102:129-34. [PMID: 18602508 DOI: 10.1016/j.amjcard.2008.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/24/2022]
Abstract
We compared the accuracy in predicting regional wall motion score index (RWMSI) changes between microvascular integrity indexes measured during primary percutaneous coronary intervention (PCI) and fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in ST-elevation myocardial infarction (STEMI). Fifty patients with STEMI were enrolled. Microvascular integrity indexes were measured using an intracoronary Doppler wire and a pressure wire after primary PCI. We performed FDG-PET 7 days after PCI. RWMSI on follow-up echocardiogram (5.8 +/- 1.7 months) revealed good correlations with coronary flow reserve (r = -0.442, p = 0.002), diastolic deceleration time (r = -0.511, p <0.001), microvascular resistance index (r = 0.443, p = 0.002), coronary wedge pressure (r = 0.474, p <0.001), and FDG uptake rate (r = -0.571, p <0.001). There were no significant differences in areas under the curve for predicting RWMSI changes between microvascular integrity indexes and FDG-PET (coronary flow reserve 0.696, diastolic deceleration time 0.731, microvascular resistance index 0.748, coronary wedge pressure 0.694, Thrombolysis In Myocardial Infarction myocardial perfusion grade 0.702, and FDG-PET 0.755). In conclusion, microvascular integrity indexes assessed during primary PCI are useful and comparable to FDG-PET in predicting left ventricular functional changes in STEMI.
Collapse
|
9
|
Takalkar A, Chen W, Desjardins B, Alavi A, Torigian DA. Cardiovascular Imaging with PET, CT, and MR Imaging. PET Clin 2008; 3:411-34. [DOI: 10.1016/j.cpet.2009.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Present and future of clinical cardiovascular PET imaging in Europe—a position statement by the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2008; 35:1709-24. [DOI: 10.1007/s00259-008-0859-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 05/16/2008] [Indexed: 01/08/2023]
|
11
|
Wu YW, Tadamura E, Kanao S, Yamamuro M, Marui A, Komeda M, Toma M, Kimura T, Togashi K. Myocardial viability by contrast-enhanced cardiovascular magnetic resonance in patients with coronary artery disease: comparison with gated single-photon emission tomography and FDG position emission tomography. Int J Cardiovasc Imaging 2007; 23:757-65. [PMID: 17364219 DOI: 10.1007/s10554-007-9215-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 02/14/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to assess the value of contrast-enhanced cardiovascular magnetic resonance (CMR) in viability for patients with coronary artery disease and left ventricular (LV) dysfunction (ejection fraction [EF] </=50%), comparing to gated thallium-201 ((201)Tl) single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). METHODS AND RESULTS One hundred sixteen patients (EF 37.8 +/- 16.2%) underwent stress-reinjection or rest-redistribution gated-SPECT and CMR (46 FDG-PET) within 1 month. All images were analyzed in a 17-segment and 0-4 scales system. Of 1972 segments, delayed enhancement (DE) on CMR correlated well with (201)Tl reduction (r = 0.90, p < 0.0001). The agreement of SPECT (>/=50% maximal (201)Tl activity) and CMR (</=50% DE) was 96.8% (kappa = 0.62). CMR detected more subendocardial scars in 18 subjects (60 segments). Reduced (201)Tl activity but none DE were observed in 19 subjects (76 segments; more inferior) who had lower EF and larger end-systolic volume (p < 0.05). Of 411 dysfunctional segments from 46 patients, FDG-PET (>/=50% of maximal FDG uptake) detected more viability (9%). CONCLUSION The extent of DE correlated (201)Tl activity well. CMR could detect more small infarcts, while FDG-PET could detect more viability. CMR could distinguish between artifacts or infarction on SPECT, especially in poor LV function.
Collapse
Affiliation(s)
- Yen-Wen Wu
- Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara, Sakyo-ku, Kyoto, 606-8507, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Machac J, Bacharach SL, Bateman TM, Bax JJ, Beanlands R, Bengel F, Bergmann SR, Brunken RC, Case J, Delbeke D, DiCarli MF, Garcia EV, Goldstein RA, Gropler RJ, Travin M, Patterson R, Schelbert HR. Positron emission tomography myocardial perfusion and glucose metabolism imaging. J Nucl Cardiol 2007; 13:e121-51. [PMID: 17174789 DOI: 10.1016/j.nuclcard.2006.08.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Woo SI, Tahk SJ, Yoon MH, Choi SY, Choi BJ, Lim HS, Yang HM, Hwang GS, Shin JH, Kang SJ, Choi UJ, Hwang JW, Seo GW, Kim JW, Park JS. Correlation between Thrombolysis in Myocardial Infarction, the Myocardial Perfusion Grade and the Myocardial Viability Indices after Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.11.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seong-Ill Woo
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Seung-Jea Tahk
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - So-Yeon Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Byoung-Joo Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Hong-Seok Lim
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Joon-Han Shin
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Soo-Jin Kang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Un Jung Choi
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jung-Won Hwang
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Gyeong-Woo Seo
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jin-Woo Kim
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, School of Medicine, Ajou University, Suwon, Korea
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The recent success of magnetic resonance imaging for viability assessment has raised questions about the future role of positron emission tomography and older imaging modalities in the assessment of viability. Recent information, however, indicates that positron emission tomography will remain a valuable tool. RECENT FINDINGS The primary positron emission tomography tracer used for assessment of viability is 18F-fluorodeoxyglucose, a glucose analogue that exhibits enhanced uptake in ischemic tissue. The finding of enhanced 18F-fluorodeoxyglucose uptake and a relative reduction in perfusion is considered the positron emission tomography correlate of myocardial hibernation. The mismatch pattern has been shown to identify patients with improvement in systolic function, heart failure symptoms, and prognosis with revascularization. Mismatch identifies a subset of patients with vulnerable myocardium who have a higher likelihood of a cardiac event compared with those without significant mismatch. Delay in revascularization may pose extra risk for those with mismatch. Positron emission tomography and magnetic resonance imaging demonstrate a close correlation in the detection of viable myocardium. The development of combined positron emission tomography/computed tomography scanners can reduce imaging time and improve functional-anatomic correlations. SUMMARY Positron emission tomography imaging utilizing 18F-fluorodeoxyglucose and perfusion tracers provides valuable diagnostic and prognostic information in patients with ischemic left ventricular dysfunction and has comparable accuracy to competing technologies for detection of viability.
Collapse
Affiliation(s)
- Stephen G Sawada
- Indiana University, Krannert Institute of Cardiology, Indianapolis 46202, USA.
| |
Collapse
|
15
|
Knešaurek K, Machac J. Comparison of 18F SPECT with PET in myocardial imaging: a realistic thorax-cardiac phantom study. BMC NUCLEAR MEDICINE 2006; 6:5. [PMID: 17076890 PMCID: PMC1634842 DOI: 10.1186/1471-2385-6-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 10/31/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Positron emission tomography (PET) imaging with fluorine-18 (18F) Fluorodeoxyglucose (FDG) and flow tracer such as Rubidium-82 (82Rb) is an established method for evaluating an ischemic but viable myocardium. However, the high cost of PET imaging restricts its wider clinical use. Therefore, less expensive 18F FDG single photon emission computed tomography (SPECT) imaging has been considered as an alternative to 18F FDG PET imaging. The purpose of the work is to compare SPECT with PET in myocardial perfusion/viability imaging. METHODS A nonuniform RH-2 thorax-heart phantom was used in the SPECT and PET acquisitions. Three inserts, 3 cm, 2 cm and 1 cm in diameter, were placed in the left ventricular (LV) wall to simulate infarcts. The phantom acquisition was performed sequentially with 7.4 MBq of 18F and 22.2 MBq of Technetium-99m (99mTc) in the SPECT study and with 7.4 MBq of 18F and 370 MBq of 82Rb in the PET study. SPECT and PET data were processed using standard reconstruction software provided by vendors. Circumferential profiles of the short-axis slices, the contrast and viability of the inserts were used to evaluate the SPECT and PET images. RESULTS The contrast for 3 cm, 2 cm and 1 cm inserts were for 18F PET data, 1.0 +/- 0.01, 0.67 +/- 0.02 and 0.25 +/- 0.01, respectively. For 82Rb PET data, the corresponding contrast values were 0.61 +/- 0.02, 0.37 +/- 0.02 and 0.19 +/- 0.01, respectively. For 18F SPECT the contrast values were, 0.31 +/- 0.03 and 0.20 +/- 0.05 for 3 cm and 2 cm inserts, respectively. For 99mTc SPECT the contrast values were, 0.63 +/- 0.04 and 0.24 +/- 0.05 for 3 cm and 2 cm inserts respectively. In SPECT, the 1 cm insert was not detectable. In the SPECT study, all three inserts were falsely diagnosed as "viable", while in the PET study, only the 1 cm insert was diagnosed falsely "viable". CONCLUSION For smaller defects the 99mTc/18F SPECT imaging cannot entirely replace the more expensive 82Rb/18F PET for myocardial perfusion/viability imaging, due to poorer image spatial resolution and poorer defect contrast.
Collapse
Affiliation(s)
- Karin Knešaurek
- Division of Nuclear Medicine, The Mount Sinai Medical Center, New York, USA
| | - Josef Machac
- Division of Nuclear Medicine, The Mount Sinai Medical Center, New York, USA
| |
Collapse
|
16
|
Rizzello V, Poldermans D, Biagini E, Schinkel AFL, Boersma E, Elhendy A, Sozzi FB, Maat A, Roelandt JRTC, Bax JJ. Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: Role of myocardial viability. Eur J Heart Fail 2006; 8:314-20. [PMID: 16185921 DOI: 10.1016/j.ejheart.2005.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 06/04/2005] [Accepted: 07/26/2005] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated. METHODS 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with >or=4 viable segments were defined as viable and patients with <4 viable segments as nonviable. Left ventricular ejection fraction (LVEF) was assessed before and 9-12 months post-revascularisation. At the same time-points, LV volumes were measured to evaluate LV remodelling. Finally, cardiac events were noted during 5-year follow-up. RESULTS The extent of viable myocardium was comparable between diabetic and non-diabetic patients. After revascularisation, LVEF increased >or=5% in 44% of diabetic and in 40% of non-diabetic patients. LVEF only improved in patients with viable myocardium. Ongoing LV remodelling occurred in 36% and 35% of diabetic and non-diabetic patients respectively, and was related to non-viability, whereas viability protected against ongoing LV remodelling, both in diabetic and non-diabetic patients. Viability was the only predictor of survival after revascularisation. CONCLUSIONS Diabetic, viable patients with ischaemic LV dysfunction exhibit improvement in LVEF post-revascularisation with prevention of ongoing LV remodelling, similar to non-diabetic patients. Myocardial viability was also the only predictor of long-term outcome.
Collapse
|
17
|
Slart RHJA, Bax JJ, van Veldhuisen DJ, van der Wall EE, Dierckx RAJO, Jager PL. Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Int J Cardiovasc Imaging 2005; 22:63-80. [PMID: 16372139 DOI: 10.1007/s10554-005-7514-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 05/17/2005] [Indexed: 12/16/2022]
Abstract
The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be treated medically. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using (201)thallium, (99m)Tc-sestamibi, or (99m)Tc-tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic and perfusion imaging with positron emission tomography (PET) radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization. New techniques in the nuclear cardiology field, like attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and non-invasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.
Collapse
Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
18
|
Ghesani M, Depuey EG, Rozanski A. Role of F-18 FDG positron emission tomography (PET) in the assessment of myocardial viability. Echocardiography 2005; 22:165-77. [PMID: 15693785 DOI: 10.1111/j.0742-2822.2005.04032.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Positron emission tomography (PET) is a functional imaging technique with important clinical applications in cardiology, oncology, and neurology. In cardiac imaging, its role has been extensively evaluated in the noninvasive diagnosis of coronary artery disease and in the determination of prognosis. Additionally, cardiac PET with F-18 fluorodeoxyglucose (FDG) is very helpful in selection of patients with coronary artery disease and left ventricular dysfunction who would benefit from coronary artery revascularization. Cardiac PET is arguably considered by many as a gold standard in this particular application. F-18, unlike other positron emitters, has a reasonably long physical half-life, which permits its distribution through commercial radiopharmacies. This is further facilitated by increasing popularity of FDG PET in oncology, which makes cardiac FDG PET a practical option for hospitals and outpatient centers equipped with PET scanners. In addition, gamma camera single photon emission computed tomography (SPECT) systems, routinely used in nuclear medicine departments, can be equipped with coincidence circuit or high-energy 511 KeV collimators, providing a cost-effective means of FDG cardiac imaging. Myocardial utilization of glucose as a substrate is variable, depending, among other factors, on serum levels of glucose and insulin. Therefore, patient preparation is important in obtaining good-quality images and in turn allowing for accurate interpretation of myocardial viability. There are various protocols to choose from that provide diagnostic image quality in both diabetic and nondiabetic patients. Mismatch between blood flow and FDG metabolism, an indicator of viable, jeopardized myocardium, can predict postrevascularization improvement in left ventricular function, symptomatic relief, and long-term survival.
Collapse
Affiliation(s)
- Munir Ghesani
- Division of Nuclear Medicine, Department of Radiology, St Luke's Roosevelt Hospital, New York, New York 10019, USA.
| | | | | |
Collapse
|
19
|
Sawada S, Hamoui O, Barclay J, Giger S, Fain R, Foltz J, Fineberg N, Hutchins G. Usefulness of positron emission tomography in predicting long-term outcome in patients with diabetes mellitus and ischemic left ventricular dysfunction. Am J Cardiol 2005; 96:2-8. [PMID: 15979422 DOI: 10.1016/j.amjcard.2005.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 03/03/2005] [Accepted: 03/03/2005] [Indexed: 11/19/2022]
Abstract
We assessed the value of positron emission tomography to predict long-term outcome in patients with diabetes and ischemic left ventricular (LV) dysfunction. Circumferential profiles of nitrogen-13 ammonia (NH3) and fluorine-18 fluorodeoxyglucose uptakes were obtained in 61 patients who had diabetes and ischemic LV dysfunction. Patient profiles were compared with those from a normal database. NH3 and fluorine-18 fluorodeoxyglucose defect sizes and extent of perfusion-metabolism mismatch (percentage of myocardium with fluorine-18 fluorodeoxyglucose uptake minus NH3 uptake >2 SD above the normal difference) were determined. Patients were followed every 6 months. Over a mean follow-up of 4.3 years, cardiac death occurred in 52% of patients who underwent revascularization and 61% of those who underwent medical therapy (p = 0.69). No clinical or imaging variables predicted cardiac death in patients who underwent revascularization. In those who received medical therapy, mismatch in > or =3% of the left ventricle (risk ratio 4.0, p = 0.01) was the only multivariate predictor of cardiac death. Revascularization improved survival of patients who had mismatch of > or =3% at 4 years (p = 0.003) and at 8 years (p = 0.012) of follow-up. Patients who had mismatch > or =3% and ejection fraction <30% had the greatest improvement in survival with revascularization compared with medical therapy (p <0.0001). Revascularization also improved 4-year survival of patients who had NH3 perfusion defects of > or =25% of the left ventricle (p = 0.02). In conclusion, mismatch identifies medically treated patients who have diabetes and LV dysfunction, who are at high risk for cardiac death. Intermediate- and long-term survival of patients who have diabetes and mismatch may be improved with revascularization, and those who have significant mismatch and severe LV dysfunction have the greatest benefit.
Collapse
Affiliation(s)
- Stephen Sawada
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Myocardial perfusion imaging with single-photon emission CT (SPECT) is a key investigation in the work-up of patients with coronary artery disease. PET, however, with inherently better spatial and temporal resolution, offers several advantages over SPECT. The last decade has witnessed extensive application of PET techniques to assess myocardial viability and has provided valuable information important in analyzing the risk: benefit ratio for several therapeutic measures. Recent advances in PET instrumentation and radiopharmaceuticals have generated considerable interest to use PET for evaluating an array of cardiovascular disease.
Collapse
Affiliation(s)
- Amol Takalkar
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | | | | | |
Collapse
|
21
|
Yang HS, Kang SJ, Song JK, Moon DH, Song JM, Kang DH, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Diagnosis of viable myocardium using velocity data of Doppler myocardial imaging: comparison with positron emission tomography. J Am Soc Echocardiogr 2004; 17:933-40. [PMID: 15337957 DOI: 10.1016/j.echo.2004.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To test whether velocity data of Doppler myocardial imaging (DMI) at rest is useful for diagnosis of myocardial viability, 25 consecutive patients (age 64 +/- 10 years) with regional wall-motion abnormalities at the left anterior descending coronary artery territory and left ventricular dysfunction (ejection fraction: 31 +/- 7%) underwent both DMI at rest and positron emission tomography. The peak systolic velocity (Vpeak) and postsystolic thickening (PST) velocity were measured in myocardial segments of left anterior descending coronary artery territory from apical views. A total of 71 segments were classified by positron emission tomography as normal or viable in 38 (group A) and nonviable in 33 (group B). Although Vpeak did not show any difference between groups (1.81 +/- 1.77 vs 1.29 +/- 0.94 cm/s, P =.107), PST velocity was significantly higher in group A (2.48 +/- 1.68 vs 0.89 +/- 0.72 cm/s, P <.001). The sensitivity and specificity of PST velocity > 2.0 cm/s for diagnosis of viability were 61% (23/38) and 97% (32/33), respectively. In segments with PST velocity was < or =2.0 cm/s, Vpeak > 1.8 cm/s could discriminate group A from B with a sensitivity of 67% (10/15) and a specificity of 91% (29/32). The algorithm using both PST velocity and Vpeak of DMI showed sensitivity and specificity of 87% and 88%, respectively, for diagnosis of myocardial viability. Velocity data of DMI at rest provides robust information regarding viability in selected patients, and an advantage of this technique is that no stress testing is needed.
Collapse
Affiliation(s)
- Hyun Suk Yang
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Maddahi J. Factors influencing predictive value of FDG imaging for evaluating myocardial viability. J Nucl Cardiol 2004; 11:524-6. [PMID: 15472636 DOI: 10.1016/j.nuclcard.2004.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Nanasato M, Hirayama H, Ando A, Isobe S, Nonokawa M, Kinoshita Y, Nanbu I, Yokota M, Murohara T. Incremental predictive value of myocardial scintigraphy with 123I-BMIPP in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 2004; 31:1512-21. [PMID: 15232655 DOI: 10.1007/s00259-004-1556-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2003] [Accepted: 03/24/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE It is unclear whether 123I-labelled beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) myocardial scintigraphy adds further predictive value for future cardiac events compared with the variables obtained during cardiac catheterisation in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). We therefore investigated whether 123I-BMIPP imaging in patients with AMI treated by primary PCI was useful in predicting future cardiac events. METHODS One hundred and fifty-nine patients with AMI who were treated with primary PCI and underwent left ventriculography (LVG) on admission underwent 201Tl and 123I-BMIPP myocardial scintigraphy. Scintigrams were visually classified, and the total defect score (TDS) was calculated. Major adverse cardiac events (MACE) were defined as cardiac death including sudden death, congestive heart failure and recurrence of acute coronary syndrome. Patients were followed up for a mean of 34.5 months (12-63 months). RESULTS Twenty-six patients had MACE. Kaplan-Meier analysis indicated that patients with the top 50% of 123I-BMIPP TDSs had a significantly higher rate of MACE (P=0.007). Patients with mismatch between 201Tl and 123I-BMIPP images also had significantly more MACE (P=0.02). In the prediction of MACE, the global chi-square value was 5.2 (P=0.001) based on LVEF (<45%) and the number of diseased vessels (two or three). Adding 123I-BMIPP TDS and the mismatch improved the global chi-square value (chi2=7.2) CONCLUSION Myocardial scintigraphy using 201Tl and 123I-BMIPP predicts future cardiac events in patients with AMI treated with primary PCI, and provides additional predictive value compared with the variables obtained with cardiac catheterisation alone.
Collapse
Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa, Nagoya, 466-8650 Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Schelbert HR, Beanlands R, Bengel F, Knuuti J, Dicarli M, Machac J, Patterson R. PET myocardial perfusion and glucose metabolism imaging: Part 2-Guidelines for interpretation and reporting. J Nucl Cardiol 2003; 10:557-71. [PMID: 14569249 DOI: 10.1016/j.nuclcard.2003.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Abstract
Since Tennant and Wiggers observed that coronary occlusion caused a reduction in cardiac contractile function, a lot has been written about the concept of hibernating myocardium. Known as the 'smart heart', hibernating myocardium is characterized by a persistent ventricular myocardial dysfunction with preserved viability, which improves with the relief of the ischaemia; this chronic downregulation in contractile function being a protective mechanism to reduce oxygen demand and thus ensure myocyte survival. This improvement usually results in an enrichment in the quality of life as well as enhanced ventricular function. In fact, it has been observed that the cardiac event rate in patients with viable dysfunctional left ventricular segments who are medically treated, is higher than the event rate in patients with comparable viability who are revascularized. Different degrees of histological alteration have been seen in hibernating myocardium, ranging from cellular de-differentiation (fetal phenotype) to cellular degeneration. Cellular de-differentiation has been associated with repetitive stunning. On the other hand, cellular degeneration (with more extensive fibrosis) has been associated with chronic low myocardial blood flow and a longer time to recovery after revascularization. These histological patterns may suggest an evolution from cellular de-differentiation to degeneration, which ends in scar formation if no revascularization is performed. In fact, several studies have described the clinical value of identifying and revascularizing hibernating segments as early as possible, to minimize fibrosis and morbidity from adverse events. Detection of hibernating myocardium still remains an important clinical problem. Imaging modalities to assess myocardial viability must differentiate potentially functional tissue from myocardium with no potential for functional recovery. These techniques fall into three broad categories: ventricular function assessment, myocardial perfusion imaging and myocardial metabolic imaging. PET imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) and 11C-acetate, single photon emission computed tomography (SPECT) with thallium and 99mTc-sestamibi, dobutamine echocardiograpy, magnetic resonance imaging (MRI) and fast computed tomography (CT) have been used for this purpose. PET imaging, in both perfusion and glucose metabolic activity, has become a standard for myocardial viability assessment, however, similar information may be available from carefully performed studies with perfusion tracers alone.
Collapse
Affiliation(s)
- C Mari
- Radiology Department, Nuclear Medicine Division, Stanford Hospital, Stanford University School of Medicine, 300 Pasteur Drive, Room H0101, Stanford, California 94305-5281, USA.
| | | |
Collapse
|
26
|
Abstract
Accurate assessment of myocardial viability is critical for identifying patients likely to benefit from coronary revascularization. Positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT), including higher sensitivity and specificity, as well as the ability to measure myocardial blood flow and myocardial metabolism in absolute terms, which is important in understanding the pathophysiology of ischemic cardiomyopathy. The most commonly used PET tracer is [18F]2-fluoro-2deoxy-D-glucose (FDG). The dependence of ischemic myocardium on glucose metabolism makes FDG an ideal tracer in this setting. Studies have shown positive and negative predictive values for the detection of viable myocardium in the range of 48-94%, and 73-96%, respectively. FDG is superior to SPECT using thallium or technetium myocardial perfusion agents, as well as echocardiography with dobutamine infusion. FDG PET also provides important prognostic information. Patients with evidence of myocardial viability by FDG PET have fewer cardiac events and survive longer if revascularized compared to patients who are treated medically. This article will review myocardial metabolism, PET procedures and interpretive criteria, as well as problems and limitations. Data from the literature regarding diagnostic and prognostic information will also be summarized.
Collapse
Affiliation(s)
- George Segall
- Nuclear Medicine Service, VA Palo Alto Health Care System, Palo Alto CA 94304, USA.
| |
Collapse
|
27
|
Abstract
The glucose analogue 18F-deoxyglucose allowed for the first time the ability to noninvasively probe and characterize the regional metabolism of glucose as a major fuel substrate of the human heart. Used with positron emission tomography, it became the tool for demonstrating the operation of metabolic processes, long before established in invasive or destructive experiments in animals, directly in the human myocardium. Clinical investigations with 18F-deoxy-glucose, combined with other radiotracers of the myocardium's substrate metabolism, showed the dependency of the heart's substrate selection on circulating levels of glucose, free fatty acid and insulin, and the operation of Randle's cycle in the human myocardium. Regional responses in substrate metabolism to the myocardial ischemia were now visualized entirely noninvasively as, for example, decreases in fatty acid usage and oxidation and oxygen consumption, but foremost as an increase in glucose use. Regional 18F-deoxyglucose uptake markedly in excess of myocardial blood flow in dysfunctional myocardium of patients after a myocardial infarction, with chronic coronary artery disease or with ischemic cardiomyopathy, soon became recognized as a hallmark of myocardial viability or potentially reversible contractile dysfunction. Defined as blood flow metabolism mismatch, this particular regional glucose uptake pattern identifies patients to be at high risk for cardiac events and, at the same time, to benefit most from surgical revascularization. The patterns predict a postrevascularization improvement in global left ventricular function and, even more important, in symptoms related to congestive heart failure and in long-term survival. 18F-deoxyglucose is now widely used with positron emission tomography and, more recently, with single photon emission computed tomography and radiotracers of myocardial perfursion for stratifying ischemic cardiomyopathy patients to the most efficacious treatment.
Collapse
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, School of Medicine, CA, USA
| |
Collapse
|