title: Prediction of functional recovery after revascularization in patients with chronic ischemic myocardial dysfunction:  perfusable tissue index by positron emission tomography and contrast-enhanced MRI comparison study.
abstract: OBJECTIVE
  In patients with chronic ischemic myocardial dysfunction, perfusable tissue index (PTI) obtained with positron emission tomography using oxygen-15-labeled water and carbon monoxide as tracers is inversely related to the extent of myocardial scar (nonperfusable tissue). Delayed contrast-enhanced (DCE) magnetic resonance imaging (MRI) accurately depicts the regional extent of myocardial fibrosis and predicts functional recovery after revascularization in patients with ischemic cardiomyopathy. Our aim was to compare PTI as a viability marker with DCE MRI.
  
  
  METHODS
  Fourteen patients with ischemic left ventricular dysfunction were studied with positron emission tomography, using oxygen-15-labeled water and carbon monoxide as tracers, and with contrast-enhanced MRI.
  
  
  RESULTS
  Functional improvement occurred in 38 of initially dysfunctional, revascularized segments (56%). Mean PTI was 1.04 ± 0.20 in the improved segments versus 0.85 ± 0.21 in the group without functional improvement (P<0.001). The areas under the receiver operator characteristics curves of PTI and DCE MRI were 0.7 and 0.74, respectively (P=not significant). Cutoff value of 25% DCE allowed correct identification of 82% segments with reversible dysfunction and 64% segments without reversible dysfunction. A threshold of 0.89 for PTI yielded the best diagnostic accuracy with sensitivity and specificity values of 76 and 54%, respectively.
  
  
  CONCLUSIONS
  PTI can identify viable myocardium and predict improvement in regional function after revascularization in patients with chronic ischemic left ventricular dysfunction. Its diagnostic accuracy is comparable with that of DCE MRI.
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. o.bondarenko@vumc.nl
authors: Olga
authors: O
authors: Bondarenko
authors: Paul
authors: P
authors: Knaapen
authors: Aernout M
authors: AM
authors: Beek
authors: Ronald
authors: R
authors: Boellaard
authors: Adriaan A
authors: AA
authors: Lammertsma
authors: Albert C
authors: AC
authors: van Rossum
mesh_terms: D000368:Aged; D000963:Antimetabolites; D002248:Carbon Monoxide; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D015635:Radionuclide Ventriculography / Q000379:methods*; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000963:Antimetabolites; D003287:Contrast Media; D010104:Oxygen Radioisotopes; D002248:Carbon Monoxide