Circulation, Vol 86, 1738-1742, Copyright © 1992 by American Heart Association
R de Silva, Y Yamamoto, CG Rhodes, H Iida, P Nihoyannopoulos, GJ Davies, AA Lammertsma, T Jones and A Maseri
BACKGROUND. Previous assessments of myocardial viability using positron
emission tomography (PET) relied on demonstration of glucose metabolism in
hypoperfused asynergic segments using the glucose analogue [18F]2-
fluoro-2-deoxyglucose (FDG). Recently, it was shown that myocardial
viability could be assessed by calculating the water-perfusable tissue
index (PTI) for the asynergic region. PTI represents the proportion of the
myocardium that is capable of rapid transsarcolemmal exchange of water and
thus perfusable by water. The aim of the present study was to assess
myocardial viability by PET using PTI in patients undergoing coronary
revascularization. METHODS AND RESULTS. Twelve patients with chronic
coronary artery disease and previous myocardial infarction were studied.
Analysis of transmission (tissue density) and 15O-labeled carbon monoxide
(blood pool), and 15O-labeled water (myocardial blood flow [MBF]) emission
PET data enabled the simultaneous quantification of MBF (ml.min-1.g
perfusable tissue-1) and PTI (gram of perfusable tissue per gram of total
anatomic tissue). In addition, PET imaging with FDG after 75-g oral glucose
load was performed in eight patients. Preoperative echocardiography
identified 33 hypocontractile and 26 control segments. Follow-up
echocardiography performed 3 to 5 months later demonstrated 26 of 33
segments with improved wall motion (recovery) and seven of 33 segments
without improvement (nonrecovery). MBF in the control segments (0.97 +/-
0.22 ml.min-1.g perfusable tissue- 1) was significantly higher (p <
0.001) than in both the recovery (0.73 +/- 0.18 ml.min-1.g perfusable
tissue-1) and the nonrecovery (0.45 +/- 0.11 ml.min-1.g perfusable
tissue-1) segments. PTI in the recovery regions (0.99 +/- 0.15) was > or
= 0.7 in all cases and slightly less than in control regions (1.10 +/-
0.15, p < 0.02). FDG uptake in these regions was 92 +/- 17% (n = 13) of
the uptake in control segments with normal wall motion. In the nonrecovery
group, PTI was 0.62 +/- 0.06 (p < 0.02 versus control and recovery) and
always < 0.7. In the one patient in whom a comparison with metabolic
imaging was made, FDG uptake was 46% of the uptake in a reference region
with normal wall motion. CONCLUSIONS. These data showed that contractile
recovery occurred only in segments where PTI was > or = 0.7, suggesting
that > or = 70% of myocardial tissue in a given asynergic segment should
be perfusable by water to enable contractile recovery. There was good
agreement between the PTI and FDG methods for predicting improvements in
regional wall motion after revascularization. Although further studies
should be performed in a larger patient group, the preliminary results are
promising and suggest that PTI may be a good predictor of contractile
recovery after coronary revascularization.
ARTICLES
Preoperative prediction of the outcome of coronary revascularization using positron emission tomography
Medical Research Council Cyclotron, Hammersmith Hospital, London, U.K.
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