doi: 10.1161/hc3401.095099
(Circulation. 2001;104:1005.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Online Myocardial Viability Assessment in the Catheterization Laboratory via NOGA Electroanatomic Mapping
Quantitative Comparison With Thallium-201 Uptake
From the Division of Cardiology (M.G., H.S., A.K., D.G.), University Medical School of Vienna, Austria, and Technion (L.G.), Israel Institute of Technology, Faculty of Medicine, Haifa, Israel.
Correspondence to Mariann Gyöngyösi, MD, PhD, Division of Cardiology, University of Vienna Medical Center, Wahringer Gurtel 18-20, A-1090 Vienna, Austria. E-mail mariann.gyongyosi{at}akh-wien.ac.at
Background— The aim of this prospective study was to investigate the concordance between quantitative resting 201Tl uptake as an established myocardial viability index and the electrical activity of the heart, determined by NOGA nonfluoroscopic electroanatomic mapping.
Methods and Results— The myocardial resting and late resting thallium uptakes of 384 myocardial segments from 32 patients (27 males aged 65±8 years) with previous myocardial infarction and chronic stable angina were compared with unipolar voltage potentials and local shortening of the left ventricle as assessed by electroanatomic mapping. The quantitative thallium uptake data were analyzed by polar map analysis by division into 12 comparable myocardial segments, as represented in electroanatomic mapping images. Unipolar voltage potentials exhibited a significant logarithmic correlation with both resting and late resting thallium uptake (attenuation corrected: r=0.660 and r=0.744; non-attenuation corrected: r=0.623 and r=0.721). Receiver operator characteristic analyses revealed unipolar voltage cutoff points of 12.0 mV (predictive accuracy 0.853, P< 0.001; sensitivity/specificity 81%) for normal myocardium and 6.4 mV (predictive accuracy 0.901, P< 0.001; sensitivity/specificity 82%) for nonviable myocardium assessed by attenuation-corrected 201Tl late resting images and of 12.7 mV (predictive accuracy 0.822, P<0.001; sensitivity/specificity 75%) and 6.5 mV (predictive accuracy 0.808, P<0.001; sensitivity/specificity 73%) for non–attenuation-corrected late resting 201Tl images.
Conclusions— These results indicate that the unipolar voltage potentials obtained by electroanatomic mapping correlate well with standard quantitative late resting 201Tl imaging for the evaluation of myocardial viability; thus, NOGA endocardial mapping provides useful "online" data at the time of catheterization, especially when information from other methods for viability assessment is unavailable.
Key Words: mapping • radioisotopes • scintigraphy • catheterization • coronary disease
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