Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction: Comparison of thallium scintigraphy with reinjection and PET imaging with18F-fluorodeoxyglucose

Robert O. Bonow, Vasken Dilsizian, Alberto Cuocolo, Stephen L. Bacharach

Research output: Contribution to journalArticlepeer-review

Abstract

In patients with chronic coronary artery disease and left ventricular dysfunction, the distinction between ventricular dysfunction arising from myocardial fibrosis and ischemic, but viable, myocardium has important clinical implications. By positron emission tomography (PET), enhanced fluorine-18-labeled fluorodeoxyglucose (FDG) uptake in myocardial segments with impaired function and reduced blood flow is evidence of myocardial viability. Reinjection of thallium-201 at rest immediately after stress-redistribution imaging may also provide evidence of myocardial viability by demonstrating thallium uptake in regions with apparently "irreversible" defects. To compare these two methods, we studied 16 patients with chronic coronary artery disease and left ventricular dysfunction (ejection fraction, 27±9%), all of whom had irreversible defects on standard exercise-redistribution thallium single-photon emission computed tomography (SPECT) imaging. Thallium was reinjected immediately after the redistribution study, and SPECT images were reacquired. The patients also underwent PET imaging with FDG and oxygen-15-labeled water. A total of 432 myocardial segments were analyzed from comparable transaxial tomograms, of which 166 (38%) had irreversible thallium defects on redistribution images before reinjection. FDG uptake was demonstrated in 121 (73%) of these irreversible defects. Irreversible defects were then subgrouped according to the degree of thallium activity, relative to peak activity in normal regions. Irreversible defects with only mild (60-85% of peak activity) or moderate (50-59% of peak) reduction in thallium activity were considered viable on the basis of FDG uptake in 91% and 84% of these segments, respectively. In contrast, in irreversible defects with severe reduction in thallium activity (

Original languageEnglish
Pages (from-to)26-37
Number of pages12
JournalCirculation
Volume83
Issue number1
Publication statusPublished - 1991

Keywords

  • Coronary artery disease
  • Fluorodeoxyglucose
  • Left ventricular dysfunction
  • Myocardial viability
  • Positron emission tomography
  • Thallium-201 scintigraphy

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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