Comparison of Contrast-Enhanced MRI with 18F-FDG PET/201Tl SPECT in Dysfunctional Myocardium: Relation to Early Functional Outcome After Surgical Revascularization in Chronic Ischemic Heart Disease

Wu, Yen‐Wen; Tadamura, Eiji; Yamamuro, Masaki; Kanao, Shotaro; Marui, Akira; Tanabara, Keiichi; Komeda, Masashi; Togashi, Kaori

doi:10.2967/jnumed.106.038596

Cited by 60 publications

(34 citation statements)

References 38 publications

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“…Recent studies have suggested that delayed enhancement (DE) on contrast-enhanced MRI represents irreversible myocardial injury. 52,53 There is limited information about the correlation between the presence of DE on MRI and acetate PET findings. Combined assessment of oxygen metabolism and tissue composition might be incrementally beneficial for predicting functional improvement after CRT.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Naya

Tsukamoto

et al. 2008

Circ J

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eart failure (HF) is the final common stage of various heart diseases and has a significant effect on quality of life and prognosis. The heart relies almost exclusively on an aerobic oxidative substrate for the generation of ATP, which is required to maintain its contractile function. The balance between oxygen demand and supply is disturbed in many disease processes. The progression to HF is associated with a gradual decline in the activity of mitochondrial respiratory pathways, leading to diminished capacity for ATP production. 1 Cardiac metabolic alterations could be either adaptive or maladaptive. Furthermore, the specific etiology of HF may be of importance in the process. Cardiac metabolic alterations may correlate with the degree of left ventricular (LV) dysfunction, symptoms of HF, prognosis and the response to medical treatments. [1][2][3] For a better understanding of the pathophysiology of cardiac metabolic alterations, it is important to measure myocardial oxygen consumption (MV • O2). The clearance kinetics of 11 C-acetate, measured by positron emission tomography (PET), can be used to measure tricarboxylic acid cycle flux and thus enable noninvasive quantification of myocardial oxidative metabolism at both the global and regional levels. [2][3][4][5][6][7] The level of myocardial oxidative metabolism with failing LV systolic function has been reported to be comparable to or lower than normal LV function. 8,9 Dyssynchrony is a predictor of poor outcome and may be associated with heterogeneity of myocardial oxidative metabolism in patients with HF. Previous studies have only evaluated rather small populations because of limited availability, and clinical significance has not been clarified in broader populations with HF. In addition, the differences between ischemic (ICM) and idiopathic dilated cardiomyopathy (DCM) have not been fully investigated.Accordingly, the aims of this study were to evaluate myocardial oxidative metabolism by using 11 C-acetate PET in a cohort and to compare the oxidative alterations with clinical variables, such as symptoms of HF, left bundle branch block (LBBB) and echocardiographic parameters, in patients with ICM and DCM. Methods Study PopulationThe study population comprised 100 consecutive pa- Yuji Kuge, PhD**; Hiroyuki Tsutsui, MD*; Nagara Tamaki, MD** Background The 11 C-acetate positron emission tomography can estimate myocardial oxidative metabolism, but previous studies have only evaluated small populations and the difference between ischemic (ICM) and idiopathic dilated cardiomyopathy (DCM) has not been fully investigated. The present aims were to evaluate global and regional myocardial oxidative metabolism in a well-characterized, large population with left ventricular (LV) dysfunction in order to clarify the metabolic differences between ICM and DCM. Methods and ResultsSeventy-eight patients with ejection fraction (EF) ≤50% (33 ICM; 45 DCM) were compared with 14 healthy controls. Myocardial oxidative metabolism was estimated with a clearance rate constant (Kmono...

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Section: Discussionmentioning

confidence: 99%

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Naya

Tsukamoto

et al. 2008

Circ J

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“…The mortality rate for individuals with undiagnosed myocardial infarction is significantly higher than that for diagnosed myocardial infarction (4). DE-MRI exhibits clear advantages in subendocardial myocardial infarction and small infarcts (21,22).…”

Section: Discussionmentioning

confidence: 99%

Assessment of myocardial viability with delayed-enhancement MRI in coronary artery disease: A correlative study with coronary artery stenosis using digital subtraction angiography

Zhao

Zhang

Sun

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the correlation between the degree of coronary artery stenosis determined by digital subtraction angiography (DSA) and infarcted segments detected by delayed enhancement magnetic resonance imaging (DE-MRI). DE-MRI and DSA were performed in 40 patients with coronary artery disease. The number of myocardial segments with infarction, the transmural extent of myocardial infarction, score of myocardial infarction by MRI, degree of coronary artery stenosis and Gensini score of the coronary artery were assessed. The correlation was analyzed using Spearman's rank correlation test. Among the 40 patients, 126 infarcted myocardial segments with a total score of 307 were found by DE-MRI; the total Gensini score for coronary artery stenosis was 587. It was observed that 81.74% of the infarcted segments were at sites with >50% coronary artery stenosis. The correlation coefficient between the Gensini score and myocardial infarction score was 0.786 (P<0.001), indicating a good correlation. However, 18.26% of myocardial infarction segments were found in patients with slight coronary artery stenosis (≤25%). A correlation was identified between DSA detected coronary artery stenosis and infarcted segments detected by DE-MRI; a higher transmural extent of myocardial infarction correlated with more severe stenosis of the coronary artery. The combined use of the two tools may facilitate accurate diagnosis.

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“…The extent of viable myocardium assessed using gate-SPECT of myocardium ranging from 25 to 30 % of LV can be considered a reasonable cut-off value for a relatively accurate prediction of reverse LV remodeling onset (postoperative increase of LVEF >5 %) assessed using receiver operating curve (ROC) analysis 9 . To date, there is one study in which patients with substantial nonviable myocardium on 18 F-FDG/SPECT are predicted to have a poor early functional outcome 26 . Based on this fi nding we tested a fi xed perfusion defect parameter assessed using gated-SPECT of myocardium as a marker of a nonviable myocardial scar tissue in the light of reverse LV remodeling prediction defi ned as a simultaneous increase of LVEF of at least 5 % and decrease of EDV of at least 5 % evaluated after 11 months from revascularization, which we consider a long enough time interval for an onset of a functional recovery of hibernating regions of myocardium after coronary revascularization.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic and Cardiac Single Photon Emission Computed Tomography Predictors of Left Ventricle Reverse Remodeling After Surgical Revascularization in Patients With Ischemic Cardiomyopathy and Left Ventricle Systolic Dysfunction

Hutyra¹,

Škála²,

Kamínek³

et al. 2008

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background:The extent of scar or viable hypocontractile myocardial tissue determines postinfarction left ventricle remodeling. The aim of this pilot study was to evaluate the revascularization eff ect in a group of patients with ischemic cardiomyopathy and LV systolic dysfunction indicated for surgical revascularization, based on evidence for multivessel disease on coronarography and viable myocardium (CMR, SPECT).Aims: To evaluate the revascularization eff ect in patients with ischemic LV systolic dysfunction and to fi nd preoperative predictors of revascularization eff ect.Methods: 33 patients (64±11 years) with baseline LVEF 34.9±9.3 % were included in the study. After a follow-up of 10.7±1.2 months, ECHO and SPECT were performed again. The whole group of patients was divided according to revascularization eff ect (↑LVEF > 5 % and ↓LVESV > 5 % compared with baseline) into revascularization responders (R, n = 22) and nonresponders (NR, n = 11).Results: At baseline there was no diff erence between the subgroups in LVEF (R = 35.7±11.0 % vs. NR = 34.3±8.2 %), EDV (R = 183.6±43.2 vs. NR = 180.2±80.5 ml), ESV (R = 118.5±40.4 vs. NR = 119.7±55.2 ml).The responders showed in a revascularization eff ect subanalysis diff erences in the values of LVEF (+9.8±8.1 %, p < 0.009), reduction of EDV (-39.9±50.9 ml, p = 0.05) and ESV (-35.4±42.6 ml, p = 0,002) compared with baseline.The only preoperative parameters predicting LV reverse remodeling were the T E-Em (R = -10.6±44.1 vs. NR = 29.7±43.7 ms, p = 0.037) and the size of fi xed perfusion defect (FPD) (R = 11.9±13.5 vs. NR = 22.9±15.3 % of LV, p = 0.044).Conclusions: Patients with ischemic LV systolic dysfunction with a preoperatively determined myocardial viability develop LV reverse remodeling. The only preoperative parameters predicting LV reverse remodeling were echocardiographic T E-Em and FPD on SPECT.

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Comparison of Contrast-Enhanced MRI with 18F-FDG PET/201Tl SPECT in Dysfunctional Myocardium: Relation to Early Functional Outcome After Surgical Revascularization in Chronic Ischemic Heart Disease

Cited by 60 publications

References 38 publications

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Assessment of myocardial viability with delayed-enhancement MRI in coronary artery disease: A correlative study with coronary artery stenosis using digital subtraction angiography

Echocardiographic and Cardiac Single Photon Emission Computed Tomography Predictors of Left Ventricle Reverse Remodeling After Surgical Revascularization in Patients With Ischemic Cardiomyopathy and Left Ventricle Systolic Dysfunction

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