Miia Lehtinen1, Jukka Schildt2, Aapo Ahonen2, Päivi Nikkinen2, Kirsi Lauerma3, Juha Sinisalo4, Esko Kankuri5, Antti Vento6, Tommi Pätilä6, Ari Harjula7. 1. Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00029 HUS, Finland miia.l.lehtinen@helsinki.fi. 2. Division of Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. 3. Division of Roentgenology, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. 4. Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland. 5. Institute of Biomedicine, Pharmacology, University of Helsinki, Helsinki, Finland. 6. Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00029 HUS, Finland. 7. Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00029 HUS, Finland Institute of Biomedicine, Pharmacology, University of Helsinki, Helsinki, Finland.
Abstract
AIMS: Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are suggested to improve clinical decision-making in ischaemic cardiomyopathy. Here, we present a unique cohort of patients who underwent nuclear medicine studies and cardiac magnetic resonance imaging (MRI) both before and 1 year after coronary artery bypass (CABG) surgery to assess benefit from surgery. METHODS AND RESULTS: Before CABG, we applied three quantitative techniques using (18)F-fluorodeoxyglucose-PET and (99m)technetium-tetrofosmin-SPECT with a software tool to measure defects with hypoperfused but viable and non-viable myocardium in 15 patients. One method used solely PET, two others combined PET and SPECT at different thresholds. As a reference, we used change in left-ventricular (LV) function and volume by MRI. Preoperatively, ischaemic but viable areas detected by the method with a 10% threshold combining PET-SPECT and the PET-only method correlated significantly with preoperative regional wall thickening (WT; P = 0.03 and P = 0.005, respectively). When compared with global functional outcome (change in LV ejection fraction) and LV remodelling (change in end-diastolic volume) 1 year postoperatively, no correlation appeared with preoperative PET- or PET-SPECT-derived viable or non-viable tissue. Neither was any correlation observable between local change in WT and local preoperative defect size evaluated by any of these three methods. CONCLUSION: Preoperatively, PET and PET-SPECT with 10% threshold detected dysfunctional myocardium, but all analysis methods failed to predict 1-year functional outcome assessed by MRI. In patients with three-vessel disease and heart failure, SPECT perfusion and PET viability study results show substantial heterogeneity; this should be considered when selecting patients for revascularization. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are suggested to improve clinical decision-making in ischaemic cardiomyopathy. Here, we present a unique cohort of patients who underwent nuclear medicine studies and cardiac magnetic resonance imaging (MRI) both before and 1 year after coronary artery bypass (CABG) surgery to assess benefit from surgery. METHODS AND RESULTS: Before CABG, we applied three quantitative techniques using (18)F-fluorodeoxyglucose-PET and (99m)technetium-tetrofosmin-SPECT with a software tool to measure defects with hypoperfused but viable and non-viable myocardium in 15 patients. One method used solely PET, two others combined PET and SPECT at different thresholds. As a reference, we used change in left-ventricular (LV) function and volume by MRI. Preoperatively, ischaemic but viable areas detected by the method with a 10% threshold combining PET-SPECT and the PET-only method correlated significantly with preoperative regional wall thickening (WT; P = 0.03 and P = 0.005, respectively). When compared with global functional outcome (change in LV ejection fraction) and LV remodelling (change in end-diastolic volume) 1 year postoperatively, no correlation appeared with preoperative PET- or PET-SPECT-derived viable or non-viable tissue. Neither was any correlation observable between local change in WT and local preoperative defect size evaluated by any of these three methods. CONCLUSION: Preoperatively, PET and PET-SPECT with 10% threshold detected dysfunctional myocardium, but all analysis methods failed to predict 1-year functional outcome assessed by MRI. In patients with three-vessel disease and heart failure, SPECT perfusion and PET viability study results show substantial heterogeneity; this should be considered when selecting patients for revascularization. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Lorenzo Fassina; Giacomo Rozzi; Stefano Rossi; Simone Scacchi; Maricla Galetti; Francesco Paolo Lo Muzio; Fabrizio Del Bianco; Piero Colli Franzone; Giuseppe Petrilli; Giuseppe Faggian; Michele Miragoli Journal: Sci Rep Date: 2017-04-11 Impact factor: 4.379
Authors: Annu Nummi; Tuomo Nieminen; Tommi Pätilä; Milla Lampinen; Miia L Lehtinen; Sari Kivistö; Miia Holmström; Erika Wilkman; Kari Teittinen; Mika Laine; Juha Sinisalo; Markku Kupari; Esko Kankuri; Tatu Juvonen; Antti Vento; Raili Suojaranta; Ari Harjula Journal: Pilot Feasibility Stud Date: 2017-12-20