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Circulation, Vol 86, 1125-1137, Copyright © 1992 by American Heart Association
P Perrone-Filardi, SL Bacharach, V Dilsizian, S Maurea, JA Frank and RO Bonow
BACKGROUND. In previous studies comparing regional 201Tl (201Tl) and
18fluorodeoxyglucose (FDG) activity in patients with chronic coronary
artery disease and left ventricular dysfunction, we hypothesized that
regions with mild-to-moderate reduction in FDG activity and regions with
mild-to-moderate irreversible 201Tl defects after 3- to 4-hour
redistribution represent viable myocardium. In the present study, regional
FDG and 201Tl activities were compared with regional systolic wall
thickening by gated magnetic resonance imaging (MRI) to confirm the
presence of viable myocardium in these territories. METHODS AND RESULTS.
Twenty-five patients with chronic stable coronary artery disease and left
ventricular dysfunction (ejection fraction, 28 +/- 10) underwent exercise
201Tl tomographic imaging (SPECT), using a reinjection protocol, positron
emission tomography (PET) with FDG and H2(15)O, and gated MRI. Matched
SPECT, PET, and MRI tomograms were analyzed. From the PET data, 105 regions
had matched reduction in FDG and blood flow, of which 69 regions had
moderately reduced FDG uptake (50-79% uptake relative to a normal reference
region) and 36 had severely reduced FDG uptake (less than 50% of normal
activity). Regions with moderately reduced as compared with severely
reduced FDG activity had greater end-diastolic wall thickness (9.4 +/- 2.6
versus 8.0 +/- 3.7 mm; p less than 0.05) and regional systolic wall
thickening (1.7 +/- 2.7 versus -0.7 +/- 2.1 mm; p less than 0.01). From the
SPECT data, 169 irreversible 201Tl defects after 3-4 hour redistribution
were identified, of which 70 were mild (greater than 65 to less than 85% of
maximal 201Tl activity), 52 were moderate (50-65% of maximal activity), and
47 were severe (less than 50% of maximal activity). Regional systolic wall
thickening was greater in regions with normal 201Tl uptake (3.3 +/- 2.3 mm)
as compared with all other regions. Regions showing only mild or moderate
irreversible defects at redistribution, however, showed wall thickening
(2.4 +/- 2.4 and 2.2 +/- 2.5 mm, respectively), which was similar to that
observed in regions with reversible 201Tl defects (2.1 +/- 2.2 mm). Only
regions with severe irreversible defects at redistribution showed absence
of thickening (- 0.1 +/- 2.9 mm, p less than 0.01 versus all other groups).
After 201Tl reinjection, 12 of 47 (26%) regions with severe irreversible
defects showed enhanced 201Tl uptake. The impairment in regional systolic
wall thickening was not significantly different between 201Tl defects with
and without enhanced 201Tl uptake after reinjection. FDG activity, however,
was present in all 12 regions (100%) with enhanced 201Tl uptake after
reinjection as compared with only five of 35 (14%) that were unchanged
after reinjection (p less than 0.01). CONCLUSIONS. Therefore, preserved
wall thickness and systolic wall thickening in regions with moderate
reduction in blood flow and FDG activity, and in irreversible 201Tl defects
that are only mild-to-moderate, provide additional evidence that such
regions represent viable myocardium. Moreover, the finding of metabolic
activity and 201Tl uptake in regions with reduced blood flow and absent
wall thickening provides clinical evidence of hibernating myocardium in
humans.
ARTICLES
Regional left ventricular wall thickening. Relation to regional uptake of 18fluorodeoxyglucose and 201Tl in patients with chronic coronary artery disease and left ventricular dysfunction
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
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