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Significance of rest technetium-99m sestamibi imaging for the prediction of improvement of left ventricular dysfunction after q wave myocardial infarction: importance of infarct location adjusted thresholds

Christian A. Schneider, MD^a, Eberhard Voth, MD^*, Sybille Gawlich, MD^a, Frank M. Baer, MD^a, Michael Horst, MD, Harald Schicha, MD^*, Erland Erdmann, MD, FACC^a and Udo Sechtem, MD, FACC

^a Klinik III für Innere Medizin, Köln, Germany
^* Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, Köln, Germany
Klinik und Poliklinik für Herz- und Thoraxchirurgie, Stuttgart, Germany
Robert-Bosch Krankenhaus, Stuttgart, Germany

View larger version (70K): [in a new window]   Figure 1 (A) The RAO angiogram as the centerline analysis of a representative patient with an inferior myocardial infarction and severe hypokinesia and akinesia of the diaphragmatic and posterobasal wall. Wall motion abnormality of the central infarct region was –3.2 SD (arrows). This region was used as the reference region for the quantitative analysis of Tc-99m sestamibi and FDG uptake. The global ejection fraction was 52%. (B) Midventricular sagittal long axis slice for the analysis of Tc-99m sestamibi uptake. The average Tc-99m sestamibi uptake was 50%. (C) Midventricular sagittal long axis slice for the analysis of FDG uptake. The average FDG uptake was 68%. (D) RAO centerline analysis 4 months after angiographically proven successful revascularization. Wall motion abnormality of the central infarct region has improved by 1.76 SD to –1.44 SD. The global ejection fraction at this control angiography was 62%.

View larger version (19K): [in a new window]   Figure 2 Average Tc-99m sestamibi uptake in the central infarct regions defined as viable or nonviable by FDG PET in patients with anterior and inferior infarcts.

View larger version (18K): [in a new window]   Figure 3 Average Tc-99m sestamibi uptake in the central infarct regions defined as viable and nonviable by improvement of left ventricular function in patients with anterior or inferior infarcts.