Assessment of reversible myocardial dysfunction in chronic ischaemic heart disease: comparison of contrast-enhanced cardiovascular magnetic resonance and a combined positron emission tomography-single photon emission computed tomography imaging protocol.
OBJECTIVE
The aim of the study was to compare, in patients with chronic ischaemic cardiomyopathy, contrast-enhanced cardiovascular magnetic resonance (ce-CMR) imaging and a combined (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and (99m)Tc-sestamibi single-photon emission computed tomography (SPECT) protocols for the prediction of functional recovery after revascularization, as assessed by cine CMR.


RESULTS
Twenty-nine patients with ischaemic cardiomyopathy (ejection fraction 32 +/- 10%) were investigated with ce-CMR and PET/SPECT. For the assessment of global and regional functions, cine CMR was performed at baseline and at 6 months follow-up. For ce-CMR, the segmental extent of hyperenhancement (SEH) was quantitated, and for PET/SPECT, different viability categories were defined according to a validated quantitative protocol. Functional improvement was related to the SEH by ce-CMR, as well as to the viability categories by PET/SPECT. Sensitivity and specificity for the prediction of functional recovery at follow-up was 97 and 68% for ce-CMR and 87 and 76% for PET/SPECT. The positive predictive value was identical for both techniques (73%). However, ce-CMR achieved a higher negative predictive value (93 vs. 77%, respectively), indicating that ce-CMR may be superior to PET/SPECT for the identification of segments unlikely to recover function after revascularization. Both methods had a similar yield in the prediction of global functional improvement.


CONCLUSIONS
ce-CMR is comparable with a PET/SPECT imaging protocol for the prediction of regional and global functional improvement after revascularization. However, ce-CMR may be superior to nuclear imaging for the identification of segments that are unlikely to recover function at follow-up.
Kühl
Harald P
HP
Medical Clinic I, University Hospital, RWTH Aachen University, Germany. hkuehl@ukaachen.de
Lipke
Claudia S A
CS
Krombach
Gabriele A
GA
Katoh
Marcus
M
Battenberg
Thomas F
TF
Nowak
Bernd
B
Heussen
Nicole
N
Buecker
Arno
A
Schaefer
Wolfgang M
WM
D002908:Chronic Disease; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi