In LV aneurysm patients, LV volumes and LVEF measured by both GSPECT and GPET imaging correlated well with those determined by CMR, but should not be interchangeable in individual patients. The accuracy of LVEF measured by GSPECT and GPET was affected by the akinetic/dyskinetic segments with absent WT.

Gated F-18 FDG PET/CT moderately correlated with gated Tc-99m sestamibi SPECT in assessing LV dyssynchrony. Gated F-18 FDG PET/CT phase analysis should be cautiously applied in CAD patients with significant LV remodeling on SPECT imaging, severe LV functional impairment or poor myocardial F-18 FDG uptake.

This prospective study evaluated the accuracy of electrocardiogram-gated blood-pool SPECT (GBPS) for the assessment of left ventricular (LV) and right ventricular (RV) ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) in patients with dilated cardiomyopathy (DCM), using cardiac magnetic resonance (CMR) imaging as the reference standard. Methods: Thirty-two patients (24 men and 8 women; mean age, 51 y) with a diagnosis of idiopathic DCM underwent GBPS and CMR. LV and RV parameters including EDV, ESV, and EF from GBPS were calculated using fully automated gradient software and compared with those obtained by CMR. Results: Biventricular volumes were underestimated by GBPS, compared with CMR (P , 0.001). We found no statistical difference between these 2 methods in the assessment of LV EF (P 5 0.23), whereas RV EF was overestimated by GBPS (P , 0.001 vs. CMR). Regression analysis yielded significant correlations between GBPS and CMR in the assessments of biventricular parameters (r 5 0.83 for LV EDV, 0.88 for LV ESV, 0.89 for LV EF, 0.86 for RV EDV, 0.86 for RV ESV, and 0.62 for RV EF; all P , 0.001). Comparison of the deviations of RV indices between GBPS and CMR with the ratio of RV EDV to LV EDV showed that there was a statistically significant trend for RV volumes to be underestimated and for RV EF to be overestimated as the biventricular volumetric ratio decreased (r 5 0.61 for RV EDV, 0.68 for RV ESV, and 20.55 for RV EF; all P , 0.001). Conclusion: For patients with DCM, GBPS correlated well with CMR for the assessment of biventricular parameters, but RV indices should be cautiously interpreted.

The prognostic value of myocardial viability assessment on left ventricular (LV) aneurysms remains undetermined. We aimed, first, to evaluate the long-term survival benefit of assessing the viability of the aneurysmal myocardium in patients with ischemic cardiomyopathy and, second, in the revascularization subgroup, to compare the short-term effects on LV function and clinical symptoms in patients treated by revascularization alone or by revascularization plus aneurysmectomy. Methods: Seventy consecutive patients with an LV aneurysm who underwent 99m Tc-sestamibi SPECT and 18 F-FDG PET were followed up for a median of 6.8 y (range, 0.1-8.8 y). Only cardiac death during follow-up served as the endpoint. Patients were classified into 4 groups by aneurysmal viability and by treatment strategy (medical or surgical). Further, the effects of aneurysmectomy on LV function at 3 mo were evaluated by an analysis of revascularized patients grouped by aneurysmal viability and by aneurysmectomy. Results: Twenty-four patients were assigned to medical therapy, and 46 patients were assigned to surgery (18 revascularization alone and 28 revascularization plus aneurysmectomy). The annual cardiac mortality rate in patients with a viable aneurysm treated medically (n 5 10) was significantly higher than that in patients with a viable aneurysm treated surgically (n 5 23) (11.6% vs. 1.5%, x 2 5 12.87, P , 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n 5 14) (x 2 5 4.13, P , 0.05) or surgically (n 5 23) (x 2 5 10.46, P 5 0.001). Multivariate analysis showed that the aneurysmal mismatch score (P 5 0.003) and surgical therapy (P 5 0.001) were independent predictors of cardiac death. Improvement of LV function and symptoms after revascularization (P , 0.05) was observed in patients with revascularization plus aneurysmectomy and in patients with a viable aneurysm and revascularization only. Conclusion: Viability in LV aneurysm in patients with ischemic cardiomyopathy was a negative independent predictor of survival. Compared with medical therapy, coronary revascularization was associated with improved long-term survival, symptoms, and LV function in patients with a viable aneurysm. These findings warrant further prospective investigations.