Recovery of regional left ventricular dysfunction after coronary revascularization. Impact of myocardial viability assessed by nuclear imaging and vessel patency at follow-up angiography.
OBJECTIVE
This study sought to evaluate an imaging approach using technetium-99m sestamibi scintigraphy and positron emission tomography with fluorine-18 fluorodeoxyglucose for assessment of myocardial viability proved by serial quantitative left ventricular angiography. Furthermore, the influence of successful long-term revascularization on functional recovery was studied.


BACKGROUND
Previous studies using positron emission tomography of myocardial perfusion and metabolism have demonstrated accurate identification of myocardial viability. However, most of these studies used a qualitative or semiquantitative wall motion analysis approach.


METHODS
Nuclear imaging with semiquantitative analysis of tracer uptake was performed in 193 patients with regional wall motion abnormalities. Regions were categorized as normal, viable with perfusion/metabolism mismatch, viable without mismatch (intermediate) and scar. Seventy-two of 103 patients with subsequent revascularization underwent follow-up angiography. In 52 of 72 patients, changes in regional wall motion were measured by the centerline method from serial angiography.


RESULTS
Wall motion improved in mismatch regions from -2.2 +/- 1.0 to -1.1 +/- 1.4 SD (p < 0.001). In contrast, regions with an intermediate pattern and those with scar did not improve. Restenosis or graft occlusion influenced functional outcome because regions with preoperative mismatch and successful long-term revascularization improved at follow-up (from -2.3 +/- 1.0 to -0.8 +/- 1.4 SD, p < 0.001), whereas wall motion did not change with recurrent hypoperfusion. Metabolic imaging added diagnostic information, particularly in regions with mild and moderate perfusion defects.


CONCLUSIONS
This imaging approach allows detection of viability in regions with myocardial dysfunction. Wall motion benefits most in myocardium with perfusion/metabolism mismatch and successful long-term revascularization.
vom Dahl
J
J
Department of Internal Medicine I (Cardiology), University Hospital, Rheinisch-Westfälische-Technische Hochschule Aachen, Germany.
Altehoefer
C
C
Sheehan
F H
FH
Buechin
P
P
Uebis
R
R
Messmer
B J
BJ
Buell
U
U
Hanrath
P
P
D000368:Aged; D002470:Cell Survival; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003847:Deoxyglucose / Q000031:analogs & derivatives; D003952:Diagnostic Imaging; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology
D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi; D003847:Deoxyglucose