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J Am Coll Cardiol, 2003; 41:1341-1348, doi:10.1016/S0735-1097(03)00158-X © 2003 by the American College of Cardiology Foundation |
* Medical Clinic I, Aachen, Germany
Department of Medical Statistics, University Hospital, Aachen, Germany
Department of Cardiology, Amsterdam, The Netherlands
Department of Clinical Physics and Informatics, Amsterdam, The Netherlands
|| PET Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Manuscript received October 9, 2002; revised manuscript received November 30, 2002, accepted December 18, 2002.
* Reprint requests and correspondence: Prof. Dr. Albert C. van Rossum, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam HV 1081, The Netherlands.
ac.vrossum{at}vumc.nl
OBJECTIVES: We sought to compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease and left ventricular (LV) dysfunction.
BACKGROUND: Contrast-enhanced MRI has been shown to identify scar tissue in ischemically damaged myocardium.
METHODS: Twenty-six patients with chronic coronary artery disease and LV dysfunction (mean ejection fraction 31 ± 11%) underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), technetium-99m tetrofosmin single-photon emission computed tomography (SPECT), and ceMRI. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI, defined as the relative amount of contrast-enhanced tissue per myocardial segment, was compared with segmental FDG and tetrofosmin uptake by PET and SPECT.
RESULTS: In severely dysfunctional segments (n = 165), SEH was 9 ± 14%, 33 ± 25% (p < 0.05), and 80 ± 23% (p < 0.05) in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively. Segmental glucose uptake by PET was inversely correlated to SEH (r = –0.86, p < 0.001). By receiver operator characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At a cutoff value of 37%, SEH optimally differentiated viable from non-viable segments defined by PET. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by PET were 96% and 84%, respectively.
CONCLUSIONS: Contrast-enhanced MRI allows assessment of myocardial viability with a high accuracy, compared with FDG-PET, in patients with chronic ischemic heart disease and LV dysfunction.
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