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Circulation, Vol 83, 26-37, Copyright © 1991 by American Heart Association
RO Bonow, V Dilsizian, A Cuocolo and SL Bacharach
In patients with chronic coronary artery disease and left ventricular
dysfunction, the distinction between ventricular dysfunction arising from
myocardial fibrosis and ischemic, but viable, myocardium has important
clinical implications. By positron emission tomography (PET), enhanced
fluorine-18-labeled fluorodeoxyglucose (FDG) uptake in myocardial segments
with impaired function and reduced blood flow is evidence of myocardial
viability. Reinjection of thallium-201 at rest immediately after
stress-redistribution imaging may also provide evidence of myocardial
viability by demonstrating thallium uptake in regions with apparently
"irreversible" defects. To compare these two methods, we studied 16
patients with chronic coronary artery disease and left ventricular
dysfunction (ejection fraction, 27 +/- 9%), all of whom had irreversible
defects on standard exercise-redistribution thallium single-photon emission
computed tomography (SPECT) imaging. Thallium was reinjected immediately
after the redistribution study, and SPECT images were reacquired. The
patients also underwent PET imaging with FDG and oxygen-15-labeled water. A
total of 432 myocardial segments were analyzed from comparable transaxial
tomograms, of which 166 (38%) had irreversible thallium defects on
redistribution images before reinjection. FDG uptake was demonstrated in
121 (73%) of these irreversible defects. Irreversible defects were then
subgrouped according to the degree of thallium activity, relative to peak
activity in normal regions. Irreversible defects with only mild (60-85% of
peak activity) or moderate (50-59% of peak) reduction in thallium activity
were considered viable on the basis of FDG uptake in 91% and 84% of these
segments, respectively. In contrast, in irreversible defects with severe
reduction in thallium activity (less than 50% of peak), FDG uptake was
present in 51% of segments. In such severe defects, an identical number of
segments (51%) demonstrated enhanced uptake of thallium after reinjection.
In these severe "irreversible" defects, data on myocardial viability were
concordant by the two techniques in 88% of segments, with 45% identified as
viable and 43% identified as scar on both PET and thallium reinjection
studies. These observations suggest that thallium imaging can be used to
identify viable myocardium in patients with chronic coronary artery disease
and left ventricular dysfunction. Most irreversible defects with only mild
or moderate reduction in thallium activity represent viable myocardium as
confirmed by FDG uptake.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F- fluorodeoxyglucose
Cardiology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md. 20892.
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