Evidence of reverse mismatch with positron emission tomography imaging in a patient with reversible myocardial dysfunction.
We describe the case of a patient who came to our attention because of a reversible depression of myocardial contractility, probably due to myocarditis. A positron emission tomography study showed, in correspondence to the malfunctioning segments, a decreased F18-2-fluoro-2-deoxyglucose (F18-FDG) uptake in the presence of a normal perfusion as assessed by means of N13-labeled ammonia uptake. This phenomenon, called "reverse mismatch", shows that viability is not always dependent on FDG uptake and that it could be associated with the recovery of myocardial contractility. Some interpretations of the association between a reversible dysfunction and a reduced myocardial glucose metabolism are presented. The central role of nitric oxide and of cyclic guanosine monophosphate is hypothesized to explain both the mechanical and metabolic abnormalities.
Terlizzi
Raffaele
R
Division of Cardiology, San Giacomo Hospital, Italy. rterlizzi@cardionet.it
Suzzi
Gianleone
G
Zanco
Pierluigi
P
Candelpergher
Giovanni
G
Vaccari
Diego
D
Costa
Alessandro
A
Franceschini
Marco
M
Neri
Lucia
L
Celegon
Leopoldo
L
Chierichetti
Franca
F
D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism; D014055:Tomography, Emission-Computed; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
D019788:Fluorodeoxyglucose F18