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Role of quantitative myocardial blood flow and N-ammonia washout for viability assessment in ischemic cardiomyopathy


Benz, Dominik C; Ferro, Paola; Safa, Nico; Messerli, Michael; von Felten, Elia; Huang, Wenjie; Patriki, Dimitri; Giannopoulos, Andreas A; Fuchs, Tobias A; Gräni, Christoph; Gebhard, Catherine; Pazhenkottil, Aju P; Kaufmann, Philipp A; Buechel, Ronny R (2019). Role of quantitative myocardial blood flow and N-ammonia washout for viability assessment in ischemic cardiomyopathy. Journal of Nuclear Cardiology:Epub ahead of print.

Abstract

OBJECTIVE
Positron emission tomography (PET) integrating assessment of perfusion with N-ammonia (NH3) and viability with F-fluorodeoxyglucose (FDG) has high accuracy to identify viable, hibernating myocardium. We tested whether quantification of myocardial blood flow (MBF) and washout (k2) can predict myocardial viability using FDG as standard of reference.
METHODS
In 180 consecutive patients with ischemic cardiomyopathy, myocardium was categorized on a segment-level into normal, ischemic, hibernating, and scar. From dynamic images, stress MBF, rest MBF, and k2 were derived and myocardial flow reserve (MFR) and volume of distribution (VD) were calculated.
RESULTS
Across myocardial tissues, all parameters differed significantly. The area under the curve (AUC) was 0.564 (95% CI 0.527-0.601), 0.635 (0.599-0.671), 0.553 (0.516-0.591), 0.520 (0.482-0.559), and 0.560 (0.522-0.597) for stress MBF, rest MBF, MFR, k2, and VD. The generalized linear mixed model correctly classified 81% of scar as viable, hibernating myocardium. If the threshold of rest MBF to predict viability was set to 0.45 mL·min·g, sensitivity and specificity were 96% and 12%, respectively.
CONCLUSION
Quantitative NH3 PET parameters have low to moderate diagnostic performance to predict viability in ischemic cardiomyopathy. However, if rest MBF falls below 0.45 mL·min·g, viability testing by FDG-PET may be safely deferred.

Abstract

OBJECTIVE
Positron emission tomography (PET) integrating assessment of perfusion with N-ammonia (NH3) and viability with F-fluorodeoxyglucose (FDG) has high accuracy to identify viable, hibernating myocardium. We tested whether quantification of myocardial blood flow (MBF) and washout (k2) can predict myocardial viability using FDG as standard of reference.
METHODS
In 180 consecutive patients with ischemic cardiomyopathy, myocardium was categorized on a segment-level into normal, ischemic, hibernating, and scar. From dynamic images, stress MBF, rest MBF, and k2 were derived and myocardial flow reserve (MFR) and volume of distribution (VD) were calculated.
RESULTS
Across myocardial tissues, all parameters differed significantly. The area under the curve (AUC) was 0.564 (95% CI 0.527-0.601), 0.635 (0.599-0.671), 0.553 (0.516-0.591), 0.520 (0.482-0.559), and 0.560 (0.522-0.597) for stress MBF, rest MBF, MFR, k2, and VD. The generalized linear mixed model correctly classified 81% of scar as viable, hibernating myocardium. If the threshold of rest MBF to predict viability was set to 0.45 mL·min·g, sensitivity and specificity were 96% and 12%, respectively.
CONCLUSION
Quantitative NH3 PET parameters have low to moderate diagnostic performance to predict viability in ischemic cardiomyopathy. However, if rest MBF falls below 0.45 mL·min·g, viability testing by FDG-PET may be safely deferred.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Klinik für Konsiliarpsychiatrie und Psychosomatik
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Radiology, Nuclear Medicine and Imaging
Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:20 March 2019
Deposited On:31 Jul 2019 13:32
Last Modified:29 Jul 2020 11:02
Publisher:Springer
ISSN:1071-3581
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s12350-019-01684-1
PubMed ID:30895563

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