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Myocardial viability assessment by endocardial electroanatomic mapping: comparison with metabolic imaging and functional recovery after coronary revascularization

Karl-Christian Koch, MD^*, Juergen vom Dahl, MD, FESC^*, Monika Wenderdel^*, Bernd Nowak, MD, Wolfgang M. Schaefer, PhD, Alexander Sasse, MD^*, Christoph Stellbrink, MD^*, Udalrich Buell, MD and Peter Hanrath, MD, FACC, FESC^*

^* Medizinische Klinik I (Department of Cardiology), Aachen, Germany
Department of Nuclear Medicine, University Hospital, Aachen, Germany

View larger version (20K): [in a new window]   Figure 1 Polar plot and segmentation of the LV for positron emission computed tomography (PET)/single photon emission computed tomography (SPECT) and mapping analysis. The segmentation methods for both modalities are described in detail in the Methods section. Positron emission computed tomography/SPECT regions (n = 25) were grouped (see numbers), and mean values were calculated and assigned (same numbers for corresponding regions) to the mapping regions (n = 12).

View larger version (23K): [in a new window]   Figure 2 Percentage of regions with normal and absent metabolism (upper panel) and electrical activity (lower panel), respectively, in relation to sestamibi uptake. In the upper panel, normal metabolism is defined by an F-18 fluorodeoxyglucose (FDG) uptake 70% and absent metabolism by an uptake <50%. In the lower panel, normal electrical activity is defined by an electrogram amplitude >9 mV and absent activity as <6 mV.

View larger version (24K): [in a new window]   Figure 3 Receiver operator curve (ROC) analysis for detection of viable regions (normal perfusion, reduced perfusion but preserved metabolism) versus scar regions by the unipolar electrogram amplitude on a patient basis. The solid line represents the ROC curve for all regions (original regions n = 536); the dashed line represents the ROC curve for all regions minus the basal regions with regional unipolar amplitudes <6 mV (n = 500).

View larger version (50K): [in a new window]   Figure 4 (A) Right anterior oblique view of the left ventricular angiogram at end-diastole (ed) and end-systole (es) of a patient with severe hypokinesia of the anterior wall after anterior myocardial infarction. (B) Long- and short-axis positron emission computed tomography (PET) and single photon emission computed tomography (SPECT) images and corresponding polar maps showing an apical scar and reduced perfusion but preserved F-18 fluorodeoxyglucose (FDG) uptake in the surrounding anterior wall. (C) Unipolar amplitude map of the LV obtained by endocardial mapping (left: right anterior oblique view [RAO]; right: anteroposterior [AP] view). Color coding ranges from <6 mV (red) to >25 mV (purple). The apex is displayed with low amplitude, whereas the adjacent anterior wall has higher amplitudes. (D) Regional polar view of the unipolar amplitude map of the LV, divided into 12 regions. MIBI = Tc 99m sestamibi.

View larger version (30K): [in a new window]   Figure 5 Regional wall motion in the infarct area and control area before and six months after successful percutaneous transluminal coronary angioplasty in patients with regional unipolar electrogram amplitudes in the infarct area >7.5 mV (n = 13) and in patients with regional unipolar electrogram amplitudes in the infarct area <7.5 mV (n = 12). SD = standard deviation.