CLINICAL STUDY: CARDIOMYOPATHY
Time course and extent of improvement of dysfunctioning myocardium in patients with coronary artery disease and severely depressed left ventricular function after revascularization: correlation with positron emission tomographic findings
Felix Haas, MD*,
Norbert Augustin, MD*,
Klaus Holper, MD*,
Michael Wottke, MD*,
Christoph Haehnel, MD, MPH*,
Stephan Nekolla, PhD ,
Hans Meisner, MD*,
R.üdiger Lange, MD* and
Markus Schwaiger, MD, FACC
* Deutsches Herzzentrum Muenchen, Department of Cardiovascular Surgery, Muenchen, Germany
Technische Universitaet Muenchen, Department of Nuclear Medicine, Muenchen, Germany
Manuscript received March 24, 1999;
revised manuscript received June 13, 2000,
accepted July 20, 2000.
Reprint requests and correspondence: Dr. Markus Schwaiger, Department of Nuclear Medicine, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 Muenchen, Germany
m.schwaiger{at}lrz.tu-muenchen.de
OBJECTIVES
This study was performed to evaluate the prevalence, time course of recovery and extent of improvement of segments with a positron emission tomographic (PET) flow–metabolism mismatch and match pattern, as well as of PET segments with normal perfusion but with impaired myocardial function.
BACKGROUND
Previous studies have shown that scintigraphic techniques evaluating myocardial viability provide predictive information about the improvement of regional wall motion. However, there are little data concerning the time course and extent of improvement of segments according to preoperative scintigraphic patterns.
METHODS
Twenty-nine patients with ischemic cardiomyopathy (ejection fraction 18% to 35%) underwent preoperative PET viability assessment and were functionally assessed by two-dimensional echocardiography preoperatively and at 11 days, 14 weeks and >12 months after coronary artery bypass graft surgery.
RESULTS
In 168 (70%) of 240 dysfunctional segments, a "normal" scintigraphic pattern was present, whereas a "mismatch" pattern was observed in 24% (p < 0.01). Mismatch areas were associated with more severe preoperative wall motion abnormalities and incomplete postoperative recovery. After one year, 31% of normal scintigraphic segments, compared with only 18% of mismatch segments, showed complete functional restoration (p < 0.05).
CONCLUSIONS
These data suggest that in patients with severe left ventricular dysfunction, a scintigraphic pattern of normal perfusion and normal metabolism is more prevalent than a flow–metabolism mismatch pattern. Functional recovery is more frequent in normal scintigraphic segments, whereas in mismatch segments, postoperative recovery remains incomplete even after one year.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CAD | = coronary artery disease | | FDG | = 18-F-fluorodeoxyglucose | | LV | = left ventricular | | M | = scar tissue | | MM | = myocardium with flow–metabolism mismatch | | NN | = normal perfused but dysfunctioning myocardium | | N-13 | = nitrogen-13 | | PET | = positron emission tomography |
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