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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Veröffentlicht in:Journal of nuclear cardiology 2003-01, Vol.10 (1), p.34-45
Hauptverfasser: Nowak, Bernd, Schaefer, Wolfgang M., Koch, Karl-Christian, Kaiser, Hans-Juergen, Block, Stephan, Knackstedt, Christian, Zimny, Michael, vom Dahl, Juergen, Buell, Udalrich
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container_issue 1
container_start_page 34
container_title Journal of nuclear cardiology
container_volume 10
creator Nowak, Bernd
Schaefer, Wolfgang M.
Koch, Karl-Christian
Kaiser, Hans-Juergen
Block, Stephan
Knackstedt, Christian
Zimny, Michael
vom Dahl, Juergen
Buell, Udalrich
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
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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 &gt;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 &lt; .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 &lt; .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 &amp; 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 &gt;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 &lt; .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 &lt; .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 &amp; 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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 &gt;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 &lt; .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 &lt; .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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source MEDLINE; Springer Nature - Complete Springer Journals; Alma/SFX Local Collection
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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