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CLINICAL STUDY: DETECTION OF MYOCARDIAL VIABILITY AND STUNNING

Electromechanical mapping for determination of myocardial contractility and viability

A comparison with echocardiography, myocardial single-photon emission computed tomography, and positron emission tomography

Andreas Keck, MD^*, Klaus Hertting, MD^*, Yitzhack Schwartz, MD, Roland Kitzing, MD^*, Michael Weber, MD^*, Bernhard Leisner, MD^*, Christian Franke, MD, Edda Bahlmann, MD^*, Carsten Schneider, MD^*, Thomas Twisselmann, MD^*, Michael Weisbach, MD^*, Robert Küchler, MD^* and Karl Heinz Kuck, MD^*,*

^* St. Georg Hospital, Hamburg, Germany
Rambam Medical Center, Haifa, Israel
PET Study Group, Hamburg, Germany

Manuscript received October 23, 2000; revised manuscript received June 18, 2002, accepted June 19, 2002.

^* Reprint requests and correspondence: Dr. Karl Heinz Kuck, Cardiology Department, St. Georg Hospital, Lohmuehlenstr. 5, 20099 Hamburg, Germany.
kuckkh{at}aol.com

OBJECTIVES: The purpose of this study was to validate electromechanical viability parameters with combined myocardial perfusion and metabolic imaging and echocardiography.

BACKGROUND: The NOGA System is a catheter-based, non-fluoroscopic, three-dimensional endocardial mapping system. This unique technique allows accurate simultaneous assessment of both local electrical activity and regional contractility.

METHODS: The results of NOGA, myocardial single-photon emission computed tomography (SPECT), positron emission tomography, and echocardiography in 51 patients with coronary artery disease and a pathologic SPECT study were transcribed in a nine-segment bull’s-eye projection and compared.

RESULTS: The local shortening of normally contracting segments, as shown by echocardiography, was 9.2 ± 5.1%, which decreased to 6.6 ± 5.0% and 4.1 ± 5.2% in hypokinetic and akinetic segments. The highest unipolar voltage (11.2 ± 5.0 mV) and local shortening (8.2 ± 5.0%) characterized normally perfused segments. Fixed perfusion defects with normal or limited 18-fluoro-2-deoxy-D-glucose uptake indicating viability had a significantly higher unipolar voltage than did scar tissue (7.25 ± 2.7 vs. 5.0 ± 3.1 mV, p = 0.029).

CONCLUSIONS: Electromechanical parameters sufficiently defined the viability state of the myocardium and showed good concordance with the findings by nuclear perfusion and metabolism imaging and echocardiography. The NOGA technique provides all the relevant information immediately after coronary angiography and enables the physician to proceed with therapy in the same setting.

Abbreviations and Acronyms   FDG   18-fluoro-2-deoxy-D-glucose   FI   fragmentation index   LLS   linear local shortening   LV   left ventricle   left ventricular   PET   positron emission tomography   SPECT   single-photon emission computed tomography   99mTc   technetium-99m   UV   unipolar voltage

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