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(Circulation. 2003;108:1095.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Characterization of Dysfunctional Myocardium by Positron Emission Tomography and Magnetic Resonance

Relation to Functional Outcome After Revascularization

Patrick R. Knuesel, MD; Daniel Nanz, PhD; Christophe Wyss, MD; Martin Buechi, MD; Philip A. Kaufmann, MD; Gustav K. von Schulthess, MD, PhD; Thomas F. Lüscher, MD; Juerg Schwitter, MD

From the Division of Cardiology (M.B., P.A.K., T.F.L., J.S.), Clinic of Nuclear Medicine (D.N., C.W., P.A.K., G.K.v.S.), and Institute of Diagnostic Radiology (P.R.K.), University Hospital Zurich, Switzerland.

Correspondence to J. Schwitter, MD, Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail juerg.schwitter{at}dmr.usz.ch

Received July 30, 2001; de novo received April 18, 2003; revision received June 5, 2003; accepted June 6, 2003.

Background— Metabolic assessment of dysfunctional myocardium by PET allows prediction of functional recovery after revascularization. Contrast-enhanced MR (ce-MR) discriminates transmural distribution of viable and scar tissue with excellent spatial resolution. Both techniques were applied in ischemic chronic left ventricular dysfunction to relate metabolism and tissue composition to changes of contractile function after revascularization.

Methods and Results— Nineteen patients with myocardial infarctions (>3 months) were studied by MR and PET, and 10 patients were followed by MR 11±2 months after revascularization. In 56 to 64 segments/heart, systolic wall thickening, viable mass, and thickness of viable rim tissue were determined by MR (inversion-recovery MR with 0.25 mmol/kg Gd-chelate). [¹⁸F]Fluorodeoxyglucose (FDG) uptake and resting perfusion (¹³N-ammonia) were determined by PET. Viable tissue per segment on ce-MR correlated with FDG uptake per segment (r=0.62 and 0.82 for segments with and without flow metabolism mismatch, P<0.0001). FDG uptake 50% (a predictor of functional recovery) corresponded to a viable rim thickness of 4.5 mm on ce-MR. Thick (>4.5 mm) and metabolically viable segments (50% FDG uptake) showed functional recovery in 85%, whereas thin metabolically nonviable segments improved function in 13% (P<0.0005). Metabolically viable segments with a thin viable rim and thick segments with reduced FDG uptake improved function in only 36% and 23% of segments, respectively (NS versus thin metabolically nonviable). In these 2 classes of segments, scar per segment was higher than in thick viable segments (P<0.0001).

Conclusions— Metabolism and tissue composition discriminate various classes of dysfunctional myocardium. Most metabolically viable segments with a thick viable rim on ce-MR recover function after revascularization, whereas all other classes showed low recovery rates of contractile function.

Key Words: magnetic resonance imaging • scintigraphy • metabolism • hibernation

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