Assessment of myocardial viability in dysfunctional myocardium by resting myocardial blood flow determined with oxygen 15 water PET
Background. There is controversy about the role of decreased resting blood flow as the pathophysiologic correlate of hibernating myocardium. The aim of this study was an absolute quantification of volumetric myocardial blood flow (MBFvol) in dysfunctional myocardium with different viability conditio...
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description | Background. There is controversy about the role of decreased resting blood flow as the pathophysiologic correlate of hibernating myocardium. The aim of this study was an absolute quantification of volumetric myocardial blood flow (MBFvol) in dysfunctional myocardium with different viability conditions as defined by fluorine 18 deoxyglucose (FDG) positron emission tomography (PET) while taking into consideration the functional recovery after revascularization. The impact of MBFvol in the diagnosis of functional recovery was also investigated. Methods and Results. Forty-two patients with severe coronary artery disease and dysfunctional myocardium underwent resting oxygen 15 water PET, as well as FDG PET and technetium 99m tetrofosmin single photon emission computed tomography, all attenuation-corrected. Relative FDG and Tc-99m tetrofosmin uptake (normalized to the segment with 100% Tc-99m tetrofosmin uptake), as well as MBFvol (myocardial blood flow multiplied by the water-perfusable tissue fraction to account for the flow to the entire segment volume), were determined in 18 myocardial segments per patient. Viability in dysfunctional segments (estimated by ventriculography) with reduced Tc-99m tetrofosmin uptake of 70% or lower was classified as viable (FDG >70%, mismatch) or nonviable (FDG ≤70%, match). Fifteen patients underwent revascularization and were followed up. Mismatch segments with improved function were classified as hibernating myocardium. Mean MBFvol in viable myocardium was slightly reduced (0.60 ± 0.02 mL · min–1 · mL–1) compared with that in normokinetic myocardium (0.64 ± 0.01 mL · min–1 · mL–1) (P = .036) and was significantly higher than in nonviable myocardium (0.36 ± 0.01 mL · min–1 · mL–1) (P < .001). Receiver operating characteristic analysis confirmed an FDG uptake greater than 70% as the optimal threshold to predict functional recovery (diagnostic accuracy [ACC], 76%). MBFvol in hibernating myocardium (0.62 ± 0.04 mL · min–1 · mL–1) was not significantly reduced compared with that in normokinetic myocardium (0.66 ± 0.02 mL · min–1 · mL–1) and was significantly higher than in persistently dysfunctional myocardium (0.51 ± 0.04 mL · min–1 · mL–1) (P < .05). The ACC of MBFvol greater than 0.40 mL · min–1 · mL–1 as the threshold to predict functional recovery was 61% but did not improve the accuracy of FDG PET by itself. Conclusions. In patients with severe coronary artery disease and dysfunctional myocardium, MBFvol as determined with O |
doi_str_mv | 10.1067/mnc.2003.128743 |
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There is controversy about the role of decreased resting blood flow as the pathophysiologic correlate of hibernating myocardium. The aim of this study was an absolute quantification of volumetric myocardial blood flow (MBFvol) in dysfunctional myocardium with different viability conditions as defined by fluorine 18 deoxyglucose (FDG) positron emission tomography (PET) while taking into consideration the functional recovery after revascularization. The impact of MBFvol in the diagnosis of functional recovery was also investigated. Methods and Results. Forty-two patients with severe coronary artery disease and dysfunctional myocardium underwent resting oxygen 15 water PET, as well as FDG PET and technetium 99m tetrofosmin single photon emission computed tomography, all attenuation-corrected. Relative FDG and Tc-99m tetrofosmin uptake (normalized to the segment with 100% Tc-99m tetrofosmin uptake), as well as MBFvol (myocardial blood flow multiplied by the water-perfusable tissue fraction to account for the flow to the entire segment volume), were determined in 18 myocardial segments per patient. Viability in dysfunctional segments (estimated by ventriculography) with reduced Tc-99m tetrofosmin uptake of 70% or lower was classified as viable (FDG >70%, mismatch) or nonviable (FDG ≤70%, match). Fifteen patients underwent revascularization and were followed up. Mismatch segments with improved function were classified as hibernating myocardium. Mean MBFvol in viable myocardium was slightly reduced (0.60 ± 0.02 mL · min–1 · mL–1) compared with that in normokinetic myocardium (0.64 ± 0.01 mL · min–1 · mL–1) (P = .036) and was significantly higher than in nonviable myocardium (0.36 ± 0.01 mL · min–1 · mL–1) (P < .001). Receiver operating characteristic analysis confirmed an FDG uptake greater than 70% as the optimal threshold to predict functional recovery (diagnostic accuracy [ACC], 76%). MBFvol in hibernating myocardium (0.62 ± 0.04 mL · min–1 · mL–1) was not significantly reduced compared with that in normokinetic myocardium (0.66 ± 0.02 mL · min–1 · mL–1) and was significantly higher than in persistently dysfunctional myocardium (0.51 ± 0.04 mL · min–1 · mL–1) (P < .05). The ACC of MBFvol greater than 0.40 mL · min–1 · mL–1 as the threshold to predict functional recovery was 61% but did not improve the accuracy of FDG PET by itself. Conclusions. In patients with severe coronary artery disease and dysfunctional myocardium, MBFvol as determined with O-15 water differs significantly between viable and nonviable myocardium as determined by FDG PET and is not significantly reduced in hibernating compared with normokinetic myocardium. Therefore chronically reduced resting blood flow appears unlikely to be the pathophysiologic correlate of the functional state of hibernation. However, MBFvol does not improve the ACC of FDG PET by itself. (J Nucl Cardiol 2003;10:34-45)</description><identifier>ISSN: 1071-3581</identifier><identifier>EISSN: 1532-6551</identifier><identifier>DOI: 10.1067/mnc.2003.128743</identifier><identifier>PMID: 12569329</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Cardiovascular disease ; Coronary Angiography ; Coronary Circulation - physiology ; Coronary Disease - diagnostic imaging ; Coronary Disease - physiopathology ; Coronary Disease - therapy ; Coronary vessels ; Female ; Fluorodeoxyglucose F18 ; Hibernation ; Humans ; Male ; Medical research ; Middle Aged ; Myocardial Revascularization ; Myocardial Stunning - diagnostic imaging ; Myocardial Stunning - physiopathology ; Myocardial Stunning - therapy ; Organophosphorus Compounds ; Organotechnetium Compounds ; Radiopharmaceuticals ; Sensitivity and Specificity ; Tomography ; Tomography, Emission-Computed, Single-Photon ; Vein & artery diseases ; Water</subject><ispartof>Journal of nuclear cardiology, 2003-01, Vol.10 (1), p.34-45</ispartof><rights>2003 The American Society of Nuclear Cardiology</rights><rights>American Society of Nuclear Cardiology 2003.</rights><rights>American Society of Nuclear Cardiology 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-3bf2dd797860d93a110e3fc230aaad7e69f40edfad846b71beb2c65102614d7f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12569329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nowak, Bernd</creatorcontrib><creatorcontrib>Schaefer, Wolfgang M.</creatorcontrib><creatorcontrib>Koch, Karl-Christian</creatorcontrib><creatorcontrib>Kaiser, Hans-Juergen</creatorcontrib><creatorcontrib>Block, Stephan</creatorcontrib><creatorcontrib>Knackstedt, Christian</creatorcontrib><creatorcontrib>Zimny, Michael</creatorcontrib><creatorcontrib>vom Dahl, Juergen</creatorcontrib><creatorcontrib>Buell, Udalrich</creatorcontrib><title>Assessment of myocardial viability in dysfunctional myocardium by resting myocardial blood flow determined with oxygen 15 water PET</title><title>Journal of nuclear cardiology</title><addtitle>J Nucl Cardiol</addtitle><description>Background. There is controversy about the role of decreased resting blood flow as the pathophysiologic correlate of hibernating myocardium. The aim of this study was an absolute quantification of volumetric myocardial blood flow (MBFvol) in dysfunctional myocardium with different viability conditions as defined by fluorine 18 deoxyglucose (FDG) positron emission tomography (PET) while taking into consideration the functional recovery after revascularization. The impact of MBFvol in the diagnosis of functional recovery was also investigated. Methods and Results. Forty-two patients with severe coronary artery disease and dysfunctional myocardium underwent resting oxygen 15 water PET, as well as FDG PET and technetium 99m tetrofosmin single photon emission computed tomography, all attenuation-corrected. Relative FDG and Tc-99m tetrofosmin uptake (normalized to the segment with 100% Tc-99m tetrofosmin uptake), as well as MBFvol (myocardial blood flow multiplied by the water-perfusable tissue fraction to account for the flow to the entire segment volume), were determined in 18 myocardial segments per patient. Viability in dysfunctional segments (estimated by ventriculography) with reduced Tc-99m tetrofosmin uptake of 70% or lower was classified as viable (FDG >70%, mismatch) or nonviable (FDG ≤70%, match). Fifteen patients underwent revascularization and were followed up. Mismatch segments with improved function were classified as hibernating myocardium. Mean MBFvol in viable myocardium was slightly reduced (0.60 ± 0.02 mL · min–1 · mL–1) compared with that in normokinetic myocardium (0.64 ± 0.01 mL · min–1 · mL–1) (P = .036) and was significantly higher than in nonviable myocardium (0.36 ± 0.01 mL · min–1 · mL–1) (P < .001). Receiver operating characteristic analysis confirmed an FDG uptake greater than 70% as the optimal threshold to predict functional recovery (diagnostic accuracy [ACC], 76%). MBFvol in hibernating myocardium (0.62 ± 0.04 mL · min–1 · mL–1) was not significantly reduced compared with that in normokinetic myocardium (0.66 ± 0.02 mL · min–1 · mL–1) and was significantly higher than in persistently dysfunctional myocardium (0.51 ± 0.04 mL · min–1 · mL–1) (P < .05). The ACC of MBFvol greater than 0.40 mL · min–1 · mL–1 as the threshold to predict functional recovery was 61% but did not improve the accuracy of FDG PET by itself. Conclusions. In patients with severe coronary artery disease and dysfunctional myocardium, MBFvol as determined with O-15 water differs significantly between viable and nonviable myocardium as determined by FDG PET and is not significantly reduced in hibernating compared with normokinetic myocardium. Therefore chronically reduced resting blood flow appears unlikely to be the pathophysiologic correlate of the functional state of hibernation. However, MBFvol does not improve the ACC of FDG PET by itself. (J Nucl Cardiol 2003;10:34-45)</description><subject>Adult</subject><subject>Aged</subject><subject>Cardiovascular disease</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary Disease - therapy</subject><subject>Coronary vessels</subject><subject>Female</subject><subject>Fluorodeoxyglucose F18</subject><subject>Hibernation</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Myocardial Revascularization</subject><subject>Myocardial Stunning - diagnostic imaging</subject><subject>Myocardial Stunning - physiopathology</subject><subject>Myocardial Stunning - therapy</subject><subject>Organophosphorus Compounds</subject><subject>Organotechnetium Compounds</subject><subject>Radiopharmaceuticals</subject><subject>Sensitivity and Specificity</subject><subject>Tomography</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Vein & artery diseases</subject><subject>Water</subject><issn>1071-3581</issn><issn>1532-6551</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kctr3DAQh01paNK0596KaKE3b_Sw9TiGkD4gkBzSs5ClUapgS6lkZ-tz__Fq2S0tgZxGMN_8GM3XNO8I3hDMxdkU7YZizDaEStGxF80J6Rlted-Tl_WNBWlZL8lx87qUe4yxYkq9ao4J7bliVJ00v89LgVImiDNKHk1rsia7YEb0GMwQxjCvKETk1uKXaOeQYm39pZYJDSvKUOYQ7_6fHcaUHPJj2iIHM-QpRHBoG-YfKP1a7yAi0qOtqR10c3n7pjnyZizw9lBPm--fL28vvrZX11--XZxftZYpObds8NQ5oYTk2ClmCMHAvKUMG2OcAK58h8F542THB0EGGKjlPcGUk84Jz06bT_vch5x-LnVrPYViYRxNhLQULaiq9-llBT88Ae_TkuvPK8M6TrHsRIU-PgdRIQVlQuJd1NmesjmVksHrhxwmk1dNsN4p1FWh3inUe4V14v0hdxkmcP_4g7MKqD0A9VaPAbIuNkC04EIGO2uXwrPhfwB3zawH</recordid><startdate>200301</startdate><enddate>200301</enddate><creator>Nowak, Bernd</creator><creator>Schaefer, Wolfgang M.</creator><creator>Koch, Karl-Christian</creator><creator>Kaiser, Hans-Juergen</creator><creator>Block, Stephan</creator><creator>Knackstedt, Christian</creator><creator>Zimny, Michael</creator><creator>vom Dahl, Juergen</creator><creator>Buell, Udalrich</creator><general>Elsevier Inc</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>200301</creationdate><title>Assessment of myocardial viability in dysfunctional myocardium by resting myocardial blood flow determined with oxygen 15 water PET</title><author>Nowak, Bernd ; Schaefer, Wolfgang M. ; Koch, Karl-Christian ; Kaiser, Hans-Juergen ; Block, Stephan ; Knackstedt, Christian ; Zimny, Michael ; vom Dahl, Juergen ; Buell, Udalrich</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-3bf2dd797860d93a110e3fc230aaad7e69f40edfad846b71beb2c65102614d7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cardiovascular disease</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary Disease - therapy</topic><topic>Coronary vessels</topic><topic>Female</topic><topic>Fluorodeoxyglucose F18</topic><topic>Hibernation</topic><topic>Humans</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Myocardial Revascularization</topic><topic>Myocardial Stunning - diagnostic imaging</topic><topic>Myocardial Stunning - physiopathology</topic><topic>Myocardial Stunning - therapy</topic><topic>Organophosphorus Compounds</topic><topic>Organotechnetium Compounds</topic><topic>Radiopharmaceuticals</topic><topic>Sensitivity and Specificity</topic><topic>Tomography</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Vein & artery diseases</topic><topic>Water</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nowak, Bernd</creatorcontrib><creatorcontrib>Schaefer, Wolfgang M.</creatorcontrib><creatorcontrib>Koch, Karl-Christian</creatorcontrib><creatorcontrib>Kaiser, Hans-Juergen</creatorcontrib><creatorcontrib>Block, Stephan</creatorcontrib><creatorcontrib>Knackstedt, Christian</creatorcontrib><creatorcontrib>Zimny, Michael</creatorcontrib><creatorcontrib>vom Dahl, Juergen</creatorcontrib><creatorcontrib>Buell, Udalrich</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of nuclear cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nowak, Bernd</au><au>Schaefer, Wolfgang M.</au><au>Koch, Karl-Christian</au><au>Kaiser, Hans-Juergen</au><au>Block, Stephan</au><au>Knackstedt, Christian</au><au>Zimny, Michael</au><au>vom Dahl, Juergen</au><au>Buell, Udalrich</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of myocardial viability in dysfunctional myocardium by resting myocardial blood flow determined with oxygen 15 water PET</atitle><jtitle>Journal of nuclear cardiology</jtitle><addtitle>J Nucl Cardiol</addtitle><date>2003-01</date><risdate>2003</risdate><volume>10</volume><issue>1</issue><spage>34</spage><epage>45</epage><pages>34-45</pages><issn>1071-3581</issn><eissn>1532-6551</eissn><abstract>Background. There is controversy about the role of decreased resting blood flow as the pathophysiologic correlate of hibernating myocardium. The aim of this study was an absolute quantification of volumetric myocardial blood flow (MBFvol) in dysfunctional myocardium with different viability conditions as defined by fluorine 18 deoxyglucose (FDG) positron emission tomography (PET) while taking into consideration the functional recovery after revascularization. The impact of MBFvol in the diagnosis of functional recovery was also investigated. Methods and Results. Forty-two patients with severe coronary artery disease and dysfunctional myocardium underwent resting oxygen 15 water PET, as well as FDG PET and technetium 99m tetrofosmin single photon emission computed tomography, all attenuation-corrected. Relative FDG and Tc-99m tetrofosmin uptake (normalized to the segment with 100% Tc-99m tetrofosmin uptake), as well as MBFvol (myocardial blood flow multiplied by the water-perfusable tissue fraction to account for the flow to the entire segment volume), were determined in 18 myocardial segments per patient. Viability in dysfunctional segments (estimated by ventriculography) with reduced Tc-99m tetrofosmin uptake of 70% or lower was classified as viable (FDG >70%, mismatch) or nonviable (FDG ≤70%, match). Fifteen patients underwent revascularization and were followed up. Mismatch segments with improved function were classified as hibernating myocardium. Mean MBFvol in viable myocardium was slightly reduced (0.60 ± 0.02 mL · min–1 · mL–1) compared with that in normokinetic myocardium (0.64 ± 0.01 mL · min–1 · mL–1) (P = .036) and was significantly higher than in nonviable myocardium (0.36 ± 0.01 mL · min–1 · mL–1) (P < .001). Receiver operating characteristic analysis confirmed an FDG uptake greater than 70% as the optimal threshold to predict functional recovery (diagnostic accuracy [ACC], 76%). MBFvol in hibernating myocardium (0.62 ± 0.04 mL · min–1 · mL–1) was not significantly reduced compared with that in normokinetic myocardium (0.66 ± 0.02 mL · min–1 · mL–1) and was significantly higher than in persistently dysfunctional myocardium (0.51 ± 0.04 mL · min–1 · mL–1) (P < .05). The ACC of MBFvol greater than 0.40 mL · min–1 · mL–1 as the threshold to predict functional recovery was 61% but did not improve the accuracy of FDG PET by itself. Conclusions. In patients with severe coronary artery disease and dysfunctional myocardium, MBFvol as determined with O-15 water differs significantly between viable and nonviable myocardium as determined by FDG PET and is not significantly reduced in hibernating compared with normokinetic myocardium. Therefore chronically reduced resting blood flow appears unlikely to be the pathophysiologic correlate of the functional state of hibernation. However, MBFvol does not improve the ACC of FDG PET by itself. (J Nucl Cardiol 2003;10:34-45)</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>12569329</pmid><doi>10.1067/mnc.2003.128743</doi><tpages>12</tpages></addata></record> |
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subjects | Adult Aged Cardiovascular disease Coronary Angiography Coronary Circulation - physiology Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary Disease - therapy Coronary vessels Female Fluorodeoxyglucose F18 Hibernation Humans Male Medical research Middle Aged Myocardial Revascularization Myocardial Stunning - diagnostic imaging Myocardial Stunning - physiopathology Myocardial Stunning - therapy Organophosphorus Compounds Organotechnetium Compounds Radiopharmaceuticals Sensitivity and Specificity Tomography Tomography, Emission-Computed, Single-Photon Vein & artery diseases Water |
title | Assessment of myocardial viability in dysfunctional myocardium by resting myocardial blood flow determined with oxygen 15 water PET |
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