Published Online
on August 25, 2003

A more recent version of this article appeared on September 9, 2003

This Article Full Text (PDF) All Versions of this Article: 108/10/1208    most recent 01.CIR.0000088784.25089.D9v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by He, Z.-X. Articles by Jain, D. Search for Related Content PubMed PubMed Citation Articles by He, Z.-X. Articles by Jain, D. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Coronary Artery Disease Related Collections Cardiovascular imaging agents/Techniques Nuclear cardiology and PET

Submitted on December 9, 2002
Revised on June 18, 2003
Accepted on June 19, 2003

Direct Imaging of Exercise-Induced Myocardial Ischemia With Fluorine-18-Labeled Deoxyglucose and Tc-99m-Sestamibi in Coronary Artery Disease

Zuo-Xiang He MD, Rong-Fang Shi MD, Yong-Jian Wu MD, Yue-Qin Tian MD, Xiu-Jie Liu MD, Shi-Wen Wang MD, Rui Shen MD, Xue-Wen Qin MD, Run-Lin Gao MD, Jagat Narula MD, and Diwakar Jain MD, FRCP^*

From the Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences (Z.-X.H., R.-F.S., Y.-J.W., Y.-Q.T., X.-J.L., X.-W.Q., R.-L.G.), Institute of Geriatric Cardiology, General Hospital of Chinese PLA (S.-W.W., R.S.), Beijing, China, and Drexel University College of Medicine (J.N., D.J.), Philadelphia, Pa.

^* To whom correspondence should be addressed. E-mail: Diwakar.Jain{at}drexel.edu.

Background--Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose (¹⁸FDG).

Methods and Results--Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi (^99mTc-sestamibi) and ¹⁸FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise ¹⁸FDG myocardial images were compared with exercise-rest ^99mTc-sestamibi images and coronary angiography. Of 22 patients with 50% narrowing of 1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial ¹⁸FDG uptake (sensitivity 91%, P=NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with 50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased ¹⁸FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). ¹⁸FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial ¹⁸FDG uptake.

Conclusions--Exercise-induced myocardial ischemia can be imaged directly with ¹⁸FDG. Combined exercise ¹⁸FDG-^99mTc-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia compared with exercise-rest perfusion imaging. Direct ischemia imaging eliminates some of the limitations of presently used myocardial perfusion imaging. Large-scale clinical studies are warranted.

Key words: myocardium • ischemia • coronary artery disease • exercise • imaging

This article has been cited by other articles:

				M Yamano, T Kawasaki, and H Sugihara Direct imaging of myocardial ischaemia with [18F]fluorodeoxyglucose on exercise PET in hypertrophic cardiomyopathy Heart, July 1, 2009; 95(13): 1051 - 1051. [Full Text] [PDF]

				V. Dilsizian 18F-FDG Uptake as a Surrogate Marker for Antecedent Ischemia J. Nucl. Med., December 1, 2008; 49(12): 1909 - 1911. [Full Text] [PDF]

				K.-F. Dou, M.-F. Yang, Y.-J. Yang, D. Jain, and Z.-X. He Myocardial 18F-FDG Uptake After Exercise-Induced Myocardial Ischemia in Patients with Coronary Artery Disease J. Nucl. Med., December 1, 2008; 49(12): 1986 - 1991. [Abstract] [Full Text] [PDF]

				M. R. Vesely and V. Dilsizian Nuclear Cardiac Stress Testing in the Era of Molecular Medicine J. Nucl. Med., March 1, 2008; 49(3): 399 - 413. [Abstract] [Full Text] [PDF]

				K. L. Gould, H. Taegtmeyer, Z.-X. He, R.-F. Shi, Y.-J. Wu, Y.-Q. Tian, X.-J. Liu, X.-W. Qin, R.-L. Gao, S.-W. Wang, et al. Myocardial Ischemia, Fluorodeoxyglucose, and Severity of Coronary Artery Stenosis: The Complexities of Metabolic Remodeling in Hibernating Myocardium * Response Circulation, March 30, 2004; 109(12): e167 - e170. [Full Text] [PDF]