Cardiology Clinic, Medical Academy, University of Health Sciences, 44307 Kaunas, Lithuania.
Kaunas Region Society of Cardiology, 44307 Kaunas, Lithuania.
Medicina (Kaunas). 2022 Mar 1;58(3):368. doi: 10.3390/medicina58030368.
Background and Objectives: To compare the accuracy of multimodality imaging (myocardial perfusion imaging with single-photon emission computed tomography (SPECT MPI), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), and cardiovascular magnetic resonance (CMR) in the evaluation of left ventricle (LV) myocardial viability for the patients with the myocardial infarction (MI) and symptomatic heart failure (HF). Materials and Methods: 31 consecutive patients were included in the study prospectively, with a history of previous myocardial infarction, symptomatic HF (NYHA) functional class II or above, reduced ejection fraction (EF) ≤ 40%. All patients had confirmed atherosclerotic coronary artery disease (CAD), but conflicting opinions regarding the need for percutaneous intervention due to the suspected myocardial scar tissue. All patients underwent transthoracic echocardiography (TTE), SPECT MPI, 18F-FDG PET, and CMR with late gadolinium enhancement (LGE) examinations. Quantification of myocardial viability was assessed in a 17-segment model. All segments that were described as non-viable (score 4) by CMR LGE and PET were compared. The difference of score between CMR and PET we named reversibility score. According to this reversibility score, patients were divided into two groups: Group 1, reversibility score > 10 (viable myocardium with a chance of functional recovery after revascularization); Group 2, reversibility score ≤ 10 (less viable myocardium when revascularisation remains questionable). Results: 527 segments were compared in total. A significant difference in scores 1, 2, 3 group, and score 4 group was revealed between different modalities. CMR identified “non-viable” myocardium in 28.1% of segments across all groups, significantly different than SPECT in 11.8% PET in 6.5% Group 1 (viable myocardium group) patients had significantly higher physical tolerance (6 MWT (m) 3892 ± 94.5 vs. 301.4 ± 48.2), less dilated LV (LVEDD (mm) (TTE) 53.2 ± 7.9 vs. 63.4 ± 8.9; MM (g) (TTE) 239.5 ± 85.9 vs. 276.3 ± 62.7; LVEDD (mm) (CMR) 61.7 ± 8.1 vs. 69.0 ± 6.1; LVEDDi (mm/m2) (CMR) 29.8 ± 3.7 vs. 35.2 ± 3.1), significantly better parameters of the right heart (RV diameter (mm) (TTE) 33.4 ± 6.9 vs. 38.5 ± 5.0; TAPSE (mm) (TTE) 18.7 ± 2.0 vs. 15.2 ± 2.0), better LV SENC function (LV GLS (CMR) −14.3 ± 2.1 vs. 11.4 ± 2.9; LV GCS (CMR) −17.2 ± 4.6 vs. 12.7 ± 2.6), smaller size of involved myocardium (infarct size (%) (CMR) 24.5 ± 9.6 vs. 34.8 ± 11.1). Good correlations were found with several variables (LVEDD (CMR), LV EF (CMR), LV GCS (CMR)) with a coefficient of determination (R2) of 0.72. According to the cut-off values (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26%, and LV GCS (CMR) < −15.8), we performed prediction of non-viable myocardium (reversibility score < 10) with the overall percentage of 80.6 (Nagelkerke R2 0.57). Conclusions: LGE CMR reveals a significantly higher number of scars, and the FDG PET appears to be more optimistic in the functional recovery prediction. Moreover, using exact imaging parameters (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26% and LV GCS (CMR) < −15.8) may increase sensitivity and specificity of LGE CMR for evaluation of non-viable myocardium and lead to a better clinical solution (revascularization vs. medical treatment) even when viability is low in LGE CMR, and FDG PET is not performed.
比较多模态影像学（单光子发射计算机断层扫描（SPECT MPI）心肌灌注成像、18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET）和心血管磁共振（CMR）在评估心肌梗死后合并心力衰竭（HF）患者左心室（LV）心肌存活能力方面的准确性。材料与方法：前瞻性纳入 31 例连续患者，既往有心肌梗死病史，HF 症状（NYHA）心功能 II 级或以上，射血分数（EF）≤40%。所有患者均有明确的动脉粥样硬化性冠状动脉疾病（CAD），但由于疑似心肌瘢痕组织，对经皮介入治疗的需求存在争议。所有患者均接受了经胸超声心动图（TTE）、SPECT MPI、18F-FDG PET 和 LGE 检查。通过 17 节段模型评估心肌存活能力。将 CMR LGE 和 PET 描述为非存活（CMR LGE 和 PET 评分 4）的所有节段进行比较。我们将 CMR 和 PET 之间的评分差异命名为逆转评分。根据该逆转评分，患者被分为两组：组 1，逆转评分>10（有功能恢复机会的存活心肌）；组 2，逆转评分≤10（血管重建时仍存在存活心肌的可能性较小）。结果：共比较了 527 个节段。不同模态之间的评分 1、2、3 组和评分 4 组之间存在显著差异。CMR 在所有组中识别出“非存活”心肌的比例为 28.1%，显著高于 SPECT 的 11.8%和 PET 的 6.5%。组 1（存活心肌组）患者的体力耐受能力明显更高（6MWT（m）3892±94.5 与 301.4±48.2），LV 扩张程度较低（LVEDD（mm）（TTE）53.2±7.9 与 63.4±8.9；MM（g）（TTE）239.5±85.9 与 276.3±62.7；LVEDD（mm）（CMR）61.7±8.1 与 69.0±6.1；LVEDDi（mm/m2）（CMR）29.8±3.7 与 35.2±3.1），右心功能参数明显改善（RV 直径（mm）（TTE）33.4±6.9 与 38.5±5.0；TAPSE（mm）（TTE）18.7±2.0 与 15.2±2.0），LV 应变功能更好（LV GLS（CMR）-14.3±2.1 与-11.4±2.9；LV GCS（CMR）-17.2±4.6 与-12.7±2.6），受累心肌范围较小（CMR 梗死面积（%）24.5±9.6 与 34.8±11.1）。与多个变量（LVEDD（CMR）、LV EF（CMR）、LV GCS（CMR））均有较好的相关性，决定系数（R2）为 0.72。根据截断值（LVEDV（CMR）>330 mL、梗死面积（CMR）>26%和 LV GCS（CMR）<-15.8），我们对非存活心肌（逆转评分<10）的预测总百分比为 80.6%（Nagelkerke R2 0.57）。结论：LGE CMR 显示出明显更高的瘢痕数量，而 FDG PET 在功能恢复预测方面似乎更为乐观。此外，使用精确的成像参数（LVEDV（CMR）>330 mL、梗死面积（CMR）>26%和 LV GCS（CMR）<-15.8）可以提高 LGE CMR 评估非存活心肌的敏感性和特异性，从而在 LGE CMR 显示存活心肌较低时（并且未进行 FDG PET），为临床提供更好的治疗方案（血管重建与药物治疗）。
