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(Circulation. 1999;99:2921-2926.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Prevalence of Myocardial Viability as Detected by Positron Emission Tomography in Patients With Ischemic Cardiomyopathy
From the Ahmanson Biological Imaging Clinic/Nuclear Medicine, Department of Molecular and Medical Pharmacology, UCLA School of Medicine and Long Beach Community Medical Center, Los Angeles, Calif.
Correspondence to Johannes Czernin, MD, UCLA School of Medicine, AR-259 CHS, Los Angeles, CA 90095-6942.
Background—Detection of myocardial viability is important in patients with ischemic cardiomyopathy. Restoration of blood flow to viable myocardium is associated with improved left ventricular function and improved patient prognosis. However, the prevalence of viable myocardium in patients with ischemic cardiomyopathy is unknown.
Methods and Results—To determine the prevalence of myocardial
viability, clinical
[13N]ammonia/18F-deoxyglucose PET studies
performed in 283 patients (age, 63±10 years) with ischemic
heart disease (mean ejection fraction, 26±8%) were visually
analyzed for the presence and extent of viable and nonviable
myocardium. The myocardium was divided into 19
segments. The extent of viable myocardium was considered
"functionally" significant if 
5 segments (
25% of the left
ventricular myocardium) exhibited a blood
flow/metabolism mismatch and "prognostically"
significant if 1 to 4 left ventricular segments did so. Of
all patients, 41% had no evidence of viable myocardium,
55% had viable myocardium, and 4% had normal blood flow
and metabolism within an enlarged left ventricle.
Functionally significant viability was found in 27% and prognostically
significant viability in 28% of the patients.
Multivariate analysis revealed the presence of
angina to be the only clinical parameter associated with
the presence of functionally significant viability.
Conclusions—Revascularization might improve patient prognosis in 55% and result in improved left ventricular function in 27% of all patients with ischemic cardiomyopathy.
Key Words: coronary disease • viability • myocardium • tomography • cardiomyopathy
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