Background-Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose ( 18 FDG). Methods and Results-Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi ( 99m Tc-sestamibi) and 18 FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise 18 FDG myocardial images were compared with exercise-rest 99m Tc-sestamibi images and coronary angiography. Of 22 patients with Ն50% narrowing of Ն1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial 18 FDG uptake (sensitivity 91%, PϭNS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with Ն50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased 18 FDG uptake was seen in 34 vascular territories (sensitivity 67%, Pϭ0.008).18 FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial 18 FDG uptake. Conclusions-Exercise-induced

Estimation of the size of the septal vascular territory with MCE is accurate, safe and feasible in essentially all patients during NSRT. MCE can delineate the perfusion bed of the septal perforators and can predict the infarct size that follows ethanol injection.

In summary, patients with a previous MI and chronic heart failure could potentially benefit from isolated CABG (i.e., those who received CABG only) combined with BMMNCs delivered through a graft vessel. (Stem Cell Therapy to Improve Myocardial Function in Patients Undergoing Coronary Artery Bypass Grafting [CABG]; NCT00395811).

In this small pilot study, intensive medical therapy and PTCA were comparable at suppressing ischemia in stable patients after AMI. Sequential imaging with adenosine SPECT can track changes in PDS after anti-ischemic therapies and thereby predict subsequent outcome. Corroboration of these preliminary findings in a larger cardiac-event trial is warranted.