Circulation, Vol 86, 167-178, Copyright © 1992 by American Heart Association
Y Yamamoto, R de Silva, CG Rhodes, LI Araujo, H Iida, E Rechavia, P Nihoyannopoulos, D Hackett, AR Galassi and CJ Taylor
BACKGROUND. We have developed a new measure of myocardial viability, the
water-perfusable tissue index (PTI), which is calculated from transmission,
C15O, and H2(15)O positron emission tomography (PET) data sets. It is
defined as the proportion of the total anatomical tissue within a given
region of interest (ROI) that is capable of rapidly exchanging water and
has units g (perfusable tissue)/g (total anatomical tissue). The aim of
this study was to assess the prognostic value of PTI in predicting
improvement in regional wall motion after successful thrombolysis for acute
myocardial infarction (AMI) and to measure the myocardial blood flow to the
perfusable tissue (MBFp, ml/min/g [perfusable tissue]). Furthermore, PTI
was compared with 18FDG metabolic imaging in patients with old myocardial
infarction (OMI). METHODS AND RESULTS. PET scans were performed in healthy
volunteers (group 1, n = 8), patients with OMI (group 2, n = 15), and in
patients who were successfully thrombolysed after an AMI (group 3, n = 11).
Systolic wall thickening was measured by two-dimensional echocardiography
within 2-4 days of AMI and after 4 months to assess contractile recovery.
In the healthy volunteers, MBFp was 0.95 +/- 0.13 ml/min/g (perfusable
tissue). PTI in these regions was 1.08 +/- 0.07 g (perfusable tissue)/g
(total anatomical tissue), which was consistent with all normal myocardium
being perfusable by water. In the OMI group, the ratio of the relative
18FDG activity to the relative MBFp defect (metabolism-flow ratio) was
calculated for each asynergic segment. Regions in which the metabolism-flow
ratio was greater than or equal to 1.20 were considered reversibly injured,
whereas those in which the ratio was less than 1.20 were deemed
irreversibly injured. PTI in the former group of regions (n = 9) was 0.75
+/- 0.14 g (perfusable tissue)/g (total anatomical tissue) and was
significantly higher than in irreversibly injured regions (n = 6) (0.53 +/-
0.12 g [perfusable tissue]/g [total anatomical tissue], p less than 0.01).
Values of MBFp were similar in these segments. Seven of 12 segments in the
AMI patients showed improved systolic wall thickening on follow-up. PTI in
these recovery segments was 0.88 +/- 0.10 g (perfusable tissue)/g (total
anatomical tissue) (p = NS versus control). PTI in the nonrecovery regions
was 0.53 +/- 0.11 g (perfusable tissue)/g (total anatomical tissue), which
was similar to the segments in group 2 in which 18FDG uptake was absent.
MBFp was similar in both the recovery and nonrecovery segments in the
subacute phase. CONCLUSIONS. These data indicate that PTI may be a good
prognostic indicator for the recovery of contractile function after
successful thrombolysis and show that myocardial viability may be assessed
by PET without metabolic imaging.
ARTICLES
A new strategy for the assessment of viable myocardium and regional myocardial blood flow using 15O-water and dynamic positron emission tomography
MRC Cyclotron Unit, Hammersmith Hospital, London.
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