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European Heart Journal Advance Access published online on January 24, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi747
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received June 20, 2005
Revised January 3, 2006
Accepted January 5, 2006

Clinical research

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. Kühl 1 *, Claudia S.A. Lipke 1, Gabriele A. Krombach 2, Marcus Katoh 2, Thomas F. Battenberg 3, Bernd Nowak 4, Nicole Heussen 5, Arno Buecker 2, and Wolfgang M. Schaefer 6

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

* To whom correspondence should be addressed.
Harald P. Kühl, E-mail: hkuehl{at}ukaachen.de


  Abstract

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.

Keywords: Magnetic resonance; Positron emission tomography; Single-photon emission computed tomography; Ischaemic cardiomyopathy; Hibernation; Left ventricular function.
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