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European Heart Journal Advance Access originally published online on January 24, 2006
European Heart Journal 2006 27(7):846-853; doi:10.1093/eurheartj/ehi747
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Assessment of reversible myocardial dysfunction in chronic ischaemic heart disease: comparison of contrast-enhanced cardiovascular magnetic resonance and a combined positron emission tomography–single photon emission computed tomography imaging protocol

Harald P. Kühl1,2,*, Claudia S.A. Lipke1,2, Gabriele A. Krombach3, Marcus Katoh3, Thomas F. Battenberg1, Bernd Nowak4, Nicole Heussen5, Arno Buecker3 and Wolfgang M. Schaefer2,4

1Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen 52057, Germany
2Interdisciplinary Center for Clinical Research on Biomaterials and Tissue-Material-Interaction in Implants (IZKF Biomat), University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen 52057, Germany
3Department of Diagnostic Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen 52057, Germany
4Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen 52057, Germany
5Department of Medical Statistics, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen 52057, Germany

Received 20 June 2005; revised 3 January 2006; accepted 5 January 2006; online publish-ahead-of-print 24 January 2006.

* Corresponding author. Tel: +49 241 80 88722; fax: +49 241 80 82303. E-mail address: hkuehl{at}ukaachen.de

Aims The aim of the study was to compare, in patients with chronic ischaemic cardiomyopathy, contrast-enhanced cardiovascular magnetic resonance (ce-CMR) imaging and a combined 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 99mTc-sestamibi single-photon emission computed tomography (SPECT) protocols for the prediction of functional recovery after revascularization, as assessed by cine CMR.

Methods and results Twenty-nine patients with ischaemic cardiomyopathy (ejection fraction 32±10%) were investigated with ce-CMR and PET/SPECT. For the assessment of global and regional functions, cine CMR was performed at baseline and at 6 months follow-up. For ce-CMR, the segmental extent of hyperenhancement (SEH) was quantitated, and for PET/SPECT, different viability categories were defined according to a validated quantitative protocol. Functional improvement was related to the SEH by ce-CMR, as well as to the viability categories by PET/SPECT. Sensitivity and specificity for the prediction of functional recovery at follow-up was 97 and 68% for ce-CMR and 87 and 76% for PET/SPECT. The positive predictive value was identical for both techniques (73%). However, ce-CMR achieved a higher negative predictive value (93 vs. 77%, respectively), indicating that ce-CMR may be superior to PET/SPECT for the identification of segments unlikely to recover function after revascularization. Both methods had a similar yield in the prediction of global functional improvement.

Conclusion ce-CMR is comparable with a PET/SPECT imaging protocol for the prediction of regional and global functional improvement after revascularization. However, ce-CMR may be superior to nuclear imaging for the identification of segments that are unlikely to recover function at follow-up.

Key Words: Magnetic resonance • Positron emission tomography • Single-photon emission computed tomography • Ischaemic cardiomyopathy • Hibernation • Left ventricular function


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