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Comparison of “conventional” wall motion and perfusion imaging with F18-FDG spect imaging for myocardial viability
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
Abstracts Monday afternoon, April 7, 1997
$25
21.4
22.1
LONG-TERM CHOLESTEROL-LOWERING T R E A T M E N T AND M Y O C A R D I A L P E R F U S I O N R Nohara, R Hosokawa, L Linxue, S Tamaki, T Hashimoto, M Tanaka, S Miki, S Sasayama Kyoto University Hospital, Kyoto, JAPAN
COMPARISON OF "CONVENTIONAL" WALL MOTION AND PERFUSION IMAGING WITH FI8-FDG SPECT IMAGING FOR IvIYOCARDIAL VIABILITY. MJ Henzlova, JM DeLaTorre, G Dangas, JA Diamond, J Machac. Mt. Sinai Medical Center, New York, NY USA.
Simvastatin is reported to improve lipid metabolisms and to regress coronary atherosclerosis. But, improvement of myocardial perfusion with Simvastatin has not yet been investigated using :°~TI-SPECT. At 5 pilot study centers, 18 patients with ischemic heart disease(IHD) were enrolled and 3 dropped out; the remaining 15(male/female = 10/5, 61.6+--8.2 yr) were compared with 23 control patients(C). Total cholesteroI, triglyceride and non-HDL cholesterol levels decreased significantly, and HDL cholesterol increased after a year. Exercise(E) and resting(R) ~°~TIscore(TS) were calculated based on integrated regional uptake scores. E-TS and R-TS improved 100% in the Simvastatin-treated group, however, C showed only 10% improvement (p<0.01). Pressure-rate product and exercise time increased with improved E-TS, suggesting central effect. It also showed that the higher the level of cholesterol improvement, the greater the improvement in TS tended to be(r=0.40). Final cholesterol less than 200 mg/dl and greater than 20% reduction showed greater TS improvement. These results indicated that long-term cholesterollowering treatment with Simvastatin definitely improved coronary perfusion as demonstrated by 2°~T1-SPECT.
F18-FDG SPECT was recently introduced as an alternative to F18-FDG PET. We wished to compare conventional imaging teclmiques, singly and combined, with FDG SPECT for detection of myocardial viability. 33 pts with Hx o f MI (LVEF=31 + 9%) were imaged with FDG and Gated MIBI (G-MIBI). 20 also had Echo and 13 TI-201(TI) imaging. Viability in each o f 16 segments was defined as 50% peak FDG, MIBI or TI uptake or preserved systolic thickening by G-MIBI or Echo, in 16 segments. Viability by FDG was the gold standard for positive predictive value (PV+) and negative predictive value (PV-) calculations. T..J MIBI ECHO G-MIBI PV(+) 90% 94% 88% 86% PV(-) 55% 72% 59% 79% When non-viability by MIBI(162 segs) was combined with absence of systolic thickening, the PV(-) increased to 85% (61/72) for G-MIBI and 87%(59/68) for Echo(p<0.05). We conclude that the PV(+) o f conventional methods is acceptable compared to FDG SPECT. The PV(-) is acceptable when MIBI or TI uptake o f <50% is combined with absence o f thickening. Referral for FDG-SPECT imaging can be limited to patients with highest incremental diagnostic value.
21.5
22.2
EFFECTS OF CARDIAC ADRENERGIC NEURONS ON ENDOTHELIUM -DEPENDENT AND -INDEPENDENT CORONARY VASODILATION IN HUMANS M.Di Carli, M.Tobes, T.Mangner, A.Levine, O.Muzik, P. Chakroborty, T.B.Levine. Wayne State University, Detroit, Michigan, USA.
IMPROVEMENT OF GLOBAL LV FUNCTION AFTER REVASCULARIZATION PREDICTED BY F18FLUORODEOXYGLUCOSE SPECT.
The endothelium modulates the ability of the coronary vascular bed to dilate and thus increase myocardial blood flow (MBF) in response to adrenergic stimulation. To determine the role of spontaneous or activated cardiac efferent sympathetic signals in the regulation of MBF, we studied t4 transplant (Tx) patients (55_+9 yrs) with angiographically normal coronary arteries and no evidence of rejection, and 8 normal subjects. We used PET to delineate sympathetic innervation with [C1l]hydroxyephedrine (HED), and measure MBF with [N-13]ammonia in reinnervated and denervated coronary territories of Tx patients under basal conditions, during adenosine-induced hyperemia, and in response to sympathetic stimulation by the cold-pressor test (CPT). In the Tx patients, HED uptake was near-normal in the LAD (82+6% of normal, P=NS), but decreased in both the LCX and RCA territories (46-+3% and 39-+2% of normal respectively, P<0.01). However, basal and hyperemic MBFs were similar in all territories. In contrast, the magnitude of MBF increase in response to CPT was lower in the RCA than in the LAD territory (16-+5% vs 46+9.5%, P<0.05), despite the fact that changes in cardiac work and circulating catecholamines were the same in all regions. The magnitude of MBF increase during CPT exactly mirrored the results of liED uptake. No differences in MBF were observed in the normals. In humans, rest and hyperemic MBFs are not significantly affected by basal levels of adrenergic tone. However, the degree of MBF increase in rcsponse to sympathetic stimulation is related to the magnitude of regional norepinephrine content in cardiac adrenergic nerve terminals. This relation may affect the extent of coronary flow abnormalities in patients with cardiac sympathoneural dysfunction.
Jeroen J Bax, Jan H Cornel*, Frans C Visser**, Paolo M Fioretti#, Arthur van Lingen**, Cees A Visser**. Leiden, *Alkmaar, **Amsterdam. #Rotterdam, The Netherlands. The aim of the current study was to evaluate the efficacy of Ft8-fluorodeoxyglucose (FDG) and single photon emission computed tomography (SPECT) to predict improvement of global LV function after revascularization. Patients with poor LV function (n=22, LVEF <30%), underwent FDG SPECT during hyperinsulinemic glucose clamp, early thallium-201 SPECT (to assess perfusion) and resting echocardiographv (to assess regional contractile function). The techniques :were analyzed using a 13-segment model. Dysfunctional segments showing either normal perfusion or" Iiypoperfusion with increased FDG uptake were considered viable. Global LV function was evaluated before and 3 months after revascularization by echocardiography and/or radionuctide ventriculograpby. An l'mprovement of LVEF >5% was considered significant. A patient was considered to have substantial viability when 3 or more dysfunctional segments were viable on FDG SPECT. FDG SPECT correctly identified t2/12 (100%) of the patients that improved in LVEF as viable, whereas 8/10 (80%) patients that did not improve in LVEF were identified as nonviable. Moreover, in the patients with 3 or more viable, dysfunctional segments the LVEF increased from 25+6% to 32_+6% (P<0.01). In the remaining patients the LVEF was unchanged (24_+6% vs 25_+6%, NS). These results indicate that FDG SPECT can identify patients who improve in global LV function after revascularization.
Abstracts Monday afternoon, April 7, 1997
$25
21.4
22.1
LONG-TERM CHOLESTEROL-LOWERING T R E A T M E N T AND M Y O C A R D I A L P E R F U S I O N R Nohara, R Hosokawa, L Linxue, S Tamaki, T Hashimoto, M Tanaka, S Miki, S Sasayama Kyoto University Hospital, Kyoto, JAPAN
COMPARISON OF "CONVENTIONAL" WALL MOTION AND PERFUSION IMAGING WITH FI8-FDG SPECT IMAGING FOR IvIYOCARDIAL VIABILITY. MJ Henzlova, JM DeLaTorre, G Dangas, JA Diamond, J Machac. Mt. Sinai Medical Center, New York, NY USA.
Simvastatin is reported to improve lipid metabolisms and to regress coronary atherosclerosis. But, improvement of myocardial perfusion with Simvastatin has not yet been investigated using :°~TI-SPECT. At 5 pilot study centers, 18 patients with ischemic heart disease(IHD) were enrolled and 3 dropped out; the remaining 15(male/female = 10/5, 61.6+--8.2 yr) were compared with 23 control patients(C). Total cholesteroI, triglyceride and non-HDL cholesterol levels decreased significantly, and HDL cholesterol increased after a year. Exercise(E) and resting(R) ~°~TIscore(TS) were calculated based on integrated regional uptake scores. E-TS and R-TS improved 100% in the Simvastatin-treated group, however, C showed only 10% improvement (p<0.01). Pressure-rate product and exercise time increased with improved E-TS, suggesting central effect. It also showed that the higher the level of cholesterol improvement, the greater the improvement in TS tended to be(r=0.40). Final cholesterol less than 200 mg/dl and greater than 20% reduction showed greater TS improvement. These results indicated that long-term cholesterollowering treatment with Simvastatin definitely improved coronary perfusion as demonstrated by 2°~T1-SPECT.
F18-FDG SPECT was recently introduced as an alternative to F18-FDG PET. We wished to compare conventional imaging teclmiques, singly and combined, with FDG SPECT for detection of myocardial viability. 33 pts with Hx o f MI (LVEF=31 + 9%) were imaged with FDG and Gated MIBI (G-MIBI). 20 also had Echo and 13 TI-201(TI) imaging. Viability in each o f 16 segments was defined as 50% peak FDG, MIBI or TI uptake or preserved systolic thickening by G-MIBI or Echo, in 16 segments. Viability by FDG was the gold standard for positive predictive value (PV+) and negative predictive value (PV-) calculations. T..J MIBI ECHO G-MIBI PV(+) 90% 94% 88% 86% PV(-) 55% 72% 59% 79% When non-viability by MIBI(162 segs) was combined with absence of systolic thickening, the PV(-) increased to 85% (61/72) for G-MIBI and 87%(59/68) for Echo(p<0.05). We conclude that the PV(+) o f conventional methods is acceptable compared to FDG SPECT. The PV(-) is acceptable when MIBI or TI uptake o f <50% is combined with absence o f thickening. Referral for FDG-SPECT imaging can be limited to patients with highest incremental diagnostic value.
21.5
22.2
EFFECTS OF CARDIAC ADRENERGIC NEURONS ON ENDOTHELIUM -DEPENDENT AND -INDEPENDENT CORONARY VASODILATION IN HUMANS M.Di Carli, M.Tobes, T.Mangner, A.Levine, O.Muzik, P. Chakroborty, T.B.Levine. Wayne State University, Detroit, Michigan, USA.
IMPROVEMENT OF GLOBAL LV FUNCTION AFTER REVASCULARIZATION PREDICTED BY F18FLUORODEOXYGLUCOSE SPECT.
The endothelium modulates the ability of the coronary vascular bed to dilate and thus increase myocardial blood flow (MBF) in response to adrenergic stimulation. To determine the role of spontaneous or activated cardiac efferent sympathetic signals in the regulation of MBF, we studied t4 transplant (Tx) patients (55_+9 yrs) with angiographically normal coronary arteries and no evidence of rejection, and 8 normal subjects. We used PET to delineate sympathetic innervation with [C1l]hydroxyephedrine (HED), and measure MBF with [N-13]ammonia in reinnervated and denervated coronary territories of Tx patients under basal conditions, during adenosine-induced hyperemia, and in response to sympathetic stimulation by the cold-pressor test (CPT). In the Tx patients, HED uptake was near-normal in the LAD (82+6% of normal, P=NS), but decreased in both the LCX and RCA territories (46-+3% and 39-+2% of normal respectively, P<0.01). However, basal and hyperemic MBFs were similar in all territories. In contrast, the magnitude of MBF increase in response to CPT was lower in the RCA than in the LAD territory (16-+5% vs 46+9.5%, P<0.05), despite the fact that changes in cardiac work and circulating catecholamines were the same in all regions. The magnitude of MBF increase during CPT exactly mirrored the results of liED uptake. No differences in MBF were observed in the normals. In humans, rest and hyperemic MBFs are not significantly affected by basal levels of adrenergic tone. However, the degree of MBF increase in rcsponse to sympathetic stimulation is related to the magnitude of regional norepinephrine content in cardiac adrenergic nerve terminals. This relation may affect the extent of coronary flow abnormalities in patients with cardiac sympathoneural dysfunction.
Jeroen J Bax, Jan H Cornel*, Frans C Visser**, Paolo M Fioretti#, Arthur van Lingen**, Cees A Visser**. Leiden, *Alkmaar, **Amsterdam. #Rotterdam, The Netherlands. The aim of the current study was to evaluate the efficacy of Ft8-fluorodeoxyglucose (FDG) and single photon emission computed tomography (SPECT) to predict improvement of global LV function after revascularization. Patients with poor LV function (n=22, LVEF <30%), underwent FDG SPECT during hyperinsulinemic glucose clamp, early thallium-201 SPECT (to assess perfusion) and resting echocardiographv (to assess regional contractile function). The techniques :were analyzed using a 13-segment model. Dysfunctional segments showing either normal perfusion or" Iiypoperfusion with increased FDG uptake were considered viable. Global LV function was evaluated before and 3 months after revascularization by echocardiography and/or radionuctide ventriculograpby. An l'mprovement of LVEF >5% was considered significant. A patient was considered to have substantial viability when 3 or more dysfunctional segments were viable on FDG SPECT. FDG SPECT correctly identified t2/12 (100%) of the patients that improved in LVEF as viable, whereas 8/10 (80%) patients that did not improve in LVEF were identified as nonviable. Moreover, in the patients with 3 or more viable, dysfunctional segments the LVEF increased from 25+6% to 32_+6% (P<0.01). In the remaining patients the LVEF was unchanged (24_+6% vs 25_+6%, NS). These results indicate that FDG SPECT can identify patients who improve in global LV function after revascularization.