Relation of myocardial perfusion at rest and during pharmacologic stress to the PET patterns of tissue viability in patients with severe left ventricular dysfunction

Stress perfusion imaging can assess effectively the amount of jeopardized myocardium, but its use for identifying underperfused but viable myocardium has yielded variable results. We evaluated the relation between measurements of myocardial perfusion at rest and during pharmacologic stress and the p...

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Bibliographic Details
Published in:Journal of nuclear cardiology 1998-11, Vol.5 (6), p.558-566
Main Authors: Di Carli, M F, Asgarzadie, F, Schelbert, H R, Brunken, R C, Rokhsar, S, Maddahi, J
Format: Article
Language:English
Subjects:
Aged
Ammonia
Cardiovascular disease
Coronary Circulation - drug effects
Coronary Disease - complications
Dipyridamole - pharmacology
Female
Fluorodeoxyglucose F18
Heart - diagnostic imaging
Humans
Male
Myocardial Contraction
Myocardium - pathology
Nitrogen Radioisotopes
Radiopharmaceuticals
Tissue Survival
Tomography, Emission-Computed
Vasodilator Agents - pharmacology
Ventricular Dysfunction, Left - diagnostic imaging
Ventricular Dysfunction, Left - pathology
Ventricular Dysfunction, Left - physiopathology
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Summary:Stress perfusion imaging can assess effectively the amount of jeopardized myocardium, but its use for identifying underperfused but viable myocardium has yielded variable results. We evaluated the relation between measurements of myocardial perfusion at rest and during pharmacologic stress and the patterns of tissue viability as determined by positron emission tomographic (PET) imaging. We studied 33 patients with coronary artery disease and left ventricular (LV) dysfunction (LV ejection fraction, 30%+/-8%). PET imaging was used to evaluate regional myocardial perfusion at rest and during pharmacologic stress with [13N]-ammonia as a flow tracer, and to delineate patterns of tissue viability (i.e., perfusion-metabolism mismatch or match) using [18F]-deoxyglucose (FDG). We analyzed 429 myocardial regions, of which 229 were dysfunctional at rest. Of these, 30 had normal perfusion and 199 were hypoperfused. A severe resting defect (deficit >40% below normal) predicted lack of significant tissue viability; 31 of 35 regions (89%) had a PET match pattern denoting transmural fibrosis. Although regions with mild or moderate resting defects (deficit
ISSN:1071-3581
1532-6551
DOI:10.1016/S1071-3581(98)90109-X