Copyright © 1998 by the European Society of Cardiology.
Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability
a Department of Heart and Lung Diseases, Medical School University of Debrecen, Debrecen, Hungary
b Department of Nuclear Medicine, University of Leuven, Leuven, Belgium
c Department of Cardiology, University of Leuven, Leuven, Belgium
accepted December 1, 1997
Background
The functional significance of the anterograde and retrograde filling of coronaries on angiography is controversial.
Methods and Results
Eighteen patients with 27 severe lesions (>85% diameter stenosis) after previous extensive myocardial infarction were selected. The left ventricle was divided into 33 segments for regional comparison of epi-cardial flow (as assessed by angiography) and tissue perfusion as well as metabolism (as measured by13NH3- and18FDG-PET). Viability was defined as normal perfusion (>80% relative of maximum13NH3activity) or mismatch defect (>1·2 metabolism/flow ratio). A method has been developed to register the ‘lesion predicted region’, determined on the basis of angiography, in the same polar map as derived from the positron emission tomography data. Distal to the lesion, the anterograde epicardial flow was evaluated by Thrombolysis in Myocardial Infarction (TIMI) criteria (TIMI flow 0–3), and retrograde filling was graded on a 0–3 scale (collateral grade 0–3). TIMI flow grade and retrograde collateral grade in every lesion predicted region segment were summed to indicate the total segmental epicardial flow. Out of the 594 segments, 369 were associated with a severe lesion. Among them, significantly higher average perfusion and metabolic activities were found in segments of good epicardial filling (summed epicardial flow 
3) than in the territories of limited epi-cardial flow (summed score <3): 65·4±17% vs 45·6±10 (P=0·001%) and 68·6±16% vs 47·4±11% (P=0·0004), respectively. However, when we analysed the predictive value of angiographically detectable good epicardial flow for positron emission tomography viability criteria then the positive predictive value was found to be as low as 0·5, while the negative predictive value was considerably higher (0·82).
Conclusion
After myocardial infarction, angiographically detectable limited epicardial flow reveals scarred segments while good epicardial contrast filling does not necessarily indicate maintenance of nutritive function.
Key Words: positron emission tomography • coronary angiography • collaterals • myocardial viability
f1 Correspondence: Prof. L. Mortelmans, Department of Nuclear Medicine, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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