title: Head-to-head comparison of contrast-enhanced cardiovascular magnetic resonance and ²⁰¹Thallium single photon emission computed tomography for prediction of reversible left ventricular dysfunction in chronic ischaemic heart disease.
abstract: Delayed contrast-enhanced cardiovascular magnetic resonance (DE-CMR) allows assessment of reversibility of myocardial dysfunction. Comparative data to other modalities is scarce. Purpose of this study was to compare DE-CMR and (201)Thallium single photon emission computed tomography (SPECT) for prediction of reversible left ventricular (LV) dysfunction in patients with chronic ischaemic heart disease. Fifty-four patients with LV dysfunction (mean ejection fraction (EF) 35 ± 8%) scheduled to undergo myocardial revascularization underwent DE-CMR and SPECT. Cine CMR was performed at baseline and at 8 months follow-up for assessment of regional and global myocardial function. Myocardial viability was determined by the segmental extent of delayed enhancement for DE-CMR, and by quantitative analysis of tracer uptake for SPECT, and was correlated to functional recovery after revascularization. After revascularization, 172 (49%) of 350 dysfunctional segments improved at follow-up cine CMR. Sensitivity and specificity for the prediction of functional recovery was 92 and 88%, respectively, for DE-CMR as compared to 86% (P = 0.4) and 56% (P = 0.001) for SPECT. Global LV function showed an increase of EF > 5% in 22 (41%) patients. The DE-CMR derived viability ratio (dysfunctional but viable myocardium) of 0.46 (sensitivity 91%, specificity 91%) was identified as predictor of increase in EF > 5% (P = 0.02), whereas the corresponding SPECT parameters were not predictive. DE-CMR compares favorably to SPECT for the prediction of regional and global improvement in LV function in the setting of chronic myocardial ischemia.
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany. dres.regenfus@t-online.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Regenfus
authors.forename: Christian
authors.initials: C
authors.lastname: Schlundt
authors.forename: Johannes
authors.initials: J
authors.lastname: von Erffa
authors.forename: Michaela
authors.initials: M
authors.lastname: Schmidt
authors.forename: Udo
authors.initials: U
authors.lastname: Reulbach
authors.forename: Torsten
authors.initials: T
authors.lastname: Kuwert
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D013794:Thallium Radioisotopes