title: In vivo assessment of myocardial viability after acute myocardial infarction: A head-to-head comparison of the perfusable tissue index by PET and delayed contrast-enhanced CMR.
abstract: Early recognition of viable myocardium after acute myocardial infarction (AMI) is of clinical relevance, since affected segments have the potential of functional recovery. Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viable myocardium. An alternative parameter for detecting viability is the perfusable tissue index (PTI), derived using [15O]H2O positron emission tomography (PET), which is inversely related to the extent of myocardial scar (non-perfusable tissue). The aim of the present study was to investigate the predictive value of PTI on recovery of LV function as compared to DCE-CMR in patients with AMI, after successful percutaneous coronary intervention (PCI).
  
  
  
  Thirty-eight patients with ST elevation myocardial infarction (STEMI) successfully treated by PCI were prospectively recruited. Subjects were examined 1 week and 3 months (mean follow-up time: 97 ± 10 days) after AMI using [15O]H2O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening ≥3.0 mm at follow-up by use of CMR. A total of 588 segments were available for serial analysis.
  
  
  
  At baseline, 180 segments were dysfunctional and exhibited DCE. Seventy-three (41%) of these dysfunctional segments showed full recovery during follow-up (viable), whereas 107 (59%) segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 ± 0.09 and was significantly higher compared to nonviable segments (0.80 ± 0.13, P < .001). The optimal cut-off value for PTI was ≥0.85 with a sensitivity of 85% and specificity of 72%, and an area under the curve (AUC) of 0.82. In comparison, a cut-off value of <32% for the extent of DCE resulted in a sensitivity of 72% and a specificity of 69%, and an AUC of 0.75 (AUC PTI vs DCE P = .14).
  
  
  
  Assessment of myocardial viability shortly after reperfused AMI is feasible using PET. PET-derived PTI yields a good predictive value for the recovery of LV function in PCI-treated STEMI patients, in excellent agreement with DCE-CMR.
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Stefan A J
authors: SAJ
authors: Timmer
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands. pf.teunissen@vumc.nl.
authors: Paul F A
authors: PFA
authors: Teunissen
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.|Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Ibrahim
authors: I
authors: Danad
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Lourens F H J
authors: LFHJ
authors: Robbers
authors: Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Pieter G H M
authors: PGHM
authors: Raijmakers
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Robin
authors: R
authors: Nijveldt
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Albert C
authors: AC
authors: van Rossum
authors: Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Adriaan A
authors: AA
authors: Lammertsma
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Niels
authors: N
authors: van Royen
authors: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV, Amsterdam, The Netherlands.
authors: Paul
authors: P
authors: Knaapen
mesh_terms: D003287:Contrast Media; D042241:Early Diagnosis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology*; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014867:Water
chemical_list: D003287:Contrast Media; D010104:Oxygen Radioisotopes; C000615263:Oxygen-15; D019275:Radiopharmaceuticals; D014867:Water
keywords: Infarction; magnetic resonance imaging; myocardial; myocardial perfusion imaging: PET; myocardial viability; oxygen-15 water