(Circulation. 1995;91:1697-1705.)
© 1995 American Heart Association, Inc.
Articles |
Prediction of ReversibleIschemia After Revascularization
Perfusion and Metabolic Studies WithPositron Emission Tomography
From the Department of Radiology and Nuclear Medicine (N.T., M.K., E.T., Y.M., Y.Y., J.K.); The Third Division (R.N., S.S.), Department of Internal Medicine; and Department of Cardiovascular Surgery (K.N., T.B.), Kyoto University Faculty of Medicine, Kyoto, Japan.
Correspondence to Nagara Tamaki, MD, Department of Nuclear Medicine, Kyoto University Faculty of Medicine, Shogoin, Sakyo-ku, Kyoto, 606 Japan.
Background Accurate noninvasive determination of myocardial viability is of paramount importance for the clinical identification of patients who will benefit most from revascularization. The preserved metabolic activity in the myocardium, as studied with positron emission tomography (PET), has been considered a gold standard for this purpose. However, recent reports show that moderate hypoperfusion or stress-induced ischemia may represent reversible ischemia. The present study was undertaken to compare the value of perfusion and metabolic studies with PET for predicting improvement in wall motion after revascularization.
Methods and Results Of 61 patients who had regional asynergy and
underwent PET before revascularization, 43 patients who had successful
revascularization were included in the study. Each patient underwent
rest-stress 13N-ammonia perfusion scans and
18F-fluorodeoxyglucose (FDG) scan at rest while in a
fasting state. Reversible ischemia was considered to be present
when the resting perfusion was 
50% of the peak value, stress-induced
hypoperfusion was present, or an increase in FDG uptake was
observed. Of 130 asynergy segments, 51 segments had improved wall
motion after revascularization. The positive and negative predictive
values for improvement in asynergy were 48% and 87% by the rest
perfusion study, 63% (P=.05 versus the rest value) and 87%
by the rest-stress perfusion study, and 76% (P<.01 versus
the rest value) and 92% by the FDG study.
Conclusions FDG PET provided the best predictive value for improvement in wall motion after revascularization. On the other hand, 13N-ammonia PET is useful for predicting nonreversible myocardial scarring when it shows severe hypoperfusion at rest or hypoperfusion without stress-induced ischemia.
Key Words: tomography • ischemia • heart diseases
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