Heerajnarain Bulluck1, Steven K White2, Georg M Fröhlich1, Steven G Casson1, Celia O'Meara1, Ayla Newton1, Jennifer Nicholas1, Peter Weale1, Simon M Y Wan1, Alex Sirker1, James C Moon1, Derek M Yellon1, Ashley Groves1, Leon Menezes1, Derek J Hausenloy1. 1. From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.). 2. From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.). stevenkwhite@gmail.com.
Abstract
BACKGROUND: Hybrid positron emission tomography and magnetic resonance allows the advantages of magnetic resonance in tissue characterizing the myocardium to be combined with the unique metabolic insights of positron emission tomography. We hypothesized that the area of reduced myocardial glucose uptake would closely match the area at risk delineated by T2 mapping in ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS: Hybrid positron emission tomography and magnetic resonance using (18)F-fluorodeoxyglucose (FDG) for glucose uptake was performed in 21 ST-segment-elevation myocardial infarction patients at a median of 5 days. Follow-up scans were performed in a subset of patients 12 months later. The area of reduced FDG uptake was significantly larger than the infarct size quantified by late gadolinium enhancement (37.2±11.6% versus 22.3±11.7%; P<0.001) and closely matched the area at risk by T2 mapping (37.2±11.6% versus 36.3±12.2%; P=0.10, R=0.98, bias 0.9±4.4%). On the follow-up scans, the area of reduced FDG uptake was significantly smaller in size when compared with the acute scans (19.5 [6.3%-31.8%] versus 44.0 [21.3%-55.3%]; P=0.002) and closely correlated with the areas of late gadolinium enhancement (R 0.98) with a small bias of 2.0±5.6%. An FDG uptake of ≥45% on the acute scans could predict viable myocardium on the follow-up scan. Both transmural extent of late gadolinium enhancement and FDG uptake on the acute scan performed equally well to predict segmental wall motion recovery. CONCLUSIONS: Hybrid positron emission tomography and magnetic resonance in the reperfused ST-segment-elevation myocardial infarction patients showed reduced myocardial glucose uptake within the area at risk and closely matched the area at risk delineated by T2 mapping. FDG uptake, as well as transmural extent of late gadolinium enhancement, acutely can identify viable myocardial segments.
BACKGROUND: Hybrid positron emission tomography and magnetic resonance allows the advantages of magnetic resonance in tissue characterizing the myocardium to be combined with the unique metabolic insights of positron emission tomography. We hypothesized that the area of reduced myocardial glucose uptake would closely match the area at risk delineated by T2 mapping in ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS: Hybrid positron emission tomography and magnetic resonance using (18)F-fluorodeoxyglucose (FDG) for glucose uptake was performed in 21 ST-segment-elevation myocardial infarction patients at a median of 5 days. Follow-up scans were performed in a subset of patients 12 months later. The area of reduced FDG uptake was significantly larger than the infarct size quantified by late gadolinium enhancement (37.2±11.6% versus 22.3±11.7%; P<0.001) and closely matched the area at risk by T2 mapping (37.2±11.6% versus 36.3±12.2%; P=0.10, R=0.98, bias 0.9±4.4%). On the follow-up scans, the area of reduced FDG uptake was significantly smaller in size when compared with the acute scans (19.5 [6.3%-31.8%] versus 44.0 [21.3%-55.3%]; P=0.002) and closely correlated with the areas of late gadolinium enhancement (R 0.98) with a small bias of 2.0±5.6%. An FDG uptake of ≥45% on the acute scans could predict viable myocardium on the follow-up scan. Both transmural extent of late gadolinium enhancement and FDG uptake on the acute scan performed equally well to predict segmental wall motion recovery. CONCLUSIONS: Hybrid positron emission tomography and magnetic resonance in the reperfused ST-segment-elevation myocardial infarction patients showed reduced myocardial glucose uptake within the area at risk and closely matched the area at risk delineated by T2 mapping. FDG uptake, as well as transmural extent of late gadolinium enhancement, acutely can identify viable myocardial segments.
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