Circulation, Vol 73, 951-963, Copyright © 1986 by American Heart Association
R Brunken, J Tillisch, M Schwaiger, JS Child, R Marshall, M Mandelkern, ME Phelps and HR Schelbert
Positron-emission tomography with 13N-ammonia and 18F-2-deoxyglucose was
used to assess regional perfusion and glucose utilization in 31 chronic
electrocardiographic Q wave regions in 20 patients. With previously
published criteria, regions of infarction were identified by a concordant
reduction in regional perfusion and glucose utilization, and regions of
ischemia were identified by preservation of glucose utilization in regions
of diminished perfusion. Only 10 of the 31 regions (32%) exhibited
myocardial infarction tomographically. In contrast, positron tomography
revealed ischemia in six regions (20%) and was normal in 15 regions (48%).
Even when Q wave regions were reassigned and consolidated to enhance the
specificity of the electrocardiogram, uptake of 18F-2-deoxyglucose was
noted in the majority (54%) of the regions. Neither electrocardiographic
ST-T changes nor severity of associated wall motion abnormality reliably
distinguished tomographically identified regions of ischemia from
infarction. Thus positron tomography reveals evidence of persistent tissue
metabolism in a high proportion of chronic electrocardiographic Q wave
regions, and commonly used clinical tests do not reliably distinguish
hypoperfused but viable regions from tomographically defined regions of
myocardial infarction.
ARTICLES
Regional perfusion, glucose metabolism, and wall motion in patients with chronic electrocardiographic Q wave infarctions: evidence for persistence of viable tissue in some infarct regions by positron emission tomography
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