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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

View larger version (39K): [in a new window]   Figure 1 A zone map demonstrating the transcription of the three-dimensional NOGA map (right anterior oblique view) into a regional bull’s-eye projection. Each of the nine segments is colored differently (i.e., the apical zone is red). A = anterior; L = lateral; P = posterior; S = septal.

View larger version (36K): [in a new window]   Figure 2 A grid composed of rectangles. After an initial flexible distortion, the model was matched to the sampled points and final smoothing was obtained by applying a surface convolution and matching a grid node for each sample and moving that node to the sample location. Each grid point then received a value proportional to its distance from the neighboring points and their values, using color interpolation and smoothing.

View larger version (22K): [in a new window]   Figure 3 Correlation between NOGA parameters and echocardiography (echo). 1 = normokinesia; 2 = hypokinesia; 3 = akinesia; 4 = dyskinesia. Data are expressed as the mean value ± SD. FI = fragmentation index; LLS = linear local shortening; UV = unipolar voltage.

View larger version (21K): [in a new window]   Figure 4 Correlation between NOGA parameters and single-photon emission computed tomography (SPECT) perfusion results. Data are expressed as the mean value ± SD. FI = fragmentation index; LLS = linear local shortening; UV = unipolar voltage.

View larger version (23K): [in a new window]   Figure 5 Analysis of fixed perfusion defects by positron emission tomography (PET). A desired specificity of 90% defines a lower threshold of 4.5 mV for PET and 6 mV for single-photon emission computed tomography (SPECT). Thus, the unipolar voltage can differentiate between viable and non-viable fixed perfusion defects.

View larger version (48K): [in a new window]   Figure 6 A NOGA unipolar voltage (UV) map from a 69-year-old man with an inferior infarction six years ago and an anteroseptal infarction five years ago. The single-photon emission computed tomography (SPECT) images reveal an anteroseptal perfusion defect; the positron emission tomography (PET) polar map shows normal glucose uptake (blue) anteriorly but no glucose uptake (orange) apicoseptally. Viability assessment with the NOGA system (anteroseptal view at a slight craniocaudal angle on the UV map) provided the following information: the territory of the fixed perfusion defect is precisely depicted by voltage values <6 mV. The truly non-viable myocardium, as demonstrated by PET, is characterized by voltage values <4.5 mV; the green zone (4.5–6.0 mV) indicates viable myocardium that may benefit from revascularization.