Imaging in cardiology M.J.M. Cramer and W. Jaarsma, editors
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Figure 1.
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Tl-201 Prognostic value of viability assessment in chronic ischaemic LV dysfunction Combined assessment of myocardial perfusion with positron emission tomography (PET) or single photon emission computed tomography (SPECT), and glucose utilisation with F18-fluorodeoxyglucose (FDG) and PET or SPECT has allowed noninvasive assessment of myocardial viability.' In patients with ischaemic cardiomyopathy, the assessment of viability by FDG PET allows prediction ofimprovement ofleft ventricular function following revascularisation. In addition, the presence of viable myocardium on FDG PET is associated with a favourable long-term outcome after revascularisation.I This is in sharp contrast to the high event rate of patients with viable myocardium on FDG PET who are treated conservatively (medical therapy).'
These polar maps demonstrate the perfusion, assessed by thallium-201 SPECT (left), and the glucose utilisation, assessed by FDG SPECT during hyperinsulinaemic euglycaemic clamp (right), in a 69-yearold patient with ischaemic cardiomyopathy (old inferoseptal infarction, three-vessel coronary artery disease and a left ventricular ejection fraction of23%). He had extensive comorbidity: type II diabetes mellitus, impaired renal function and peripheral vascular disease. A large area ofhypoperfusion can be observed involving the posterolateral wall, inferior wall, and septum (left), with relatively preserved FDG uptake (right), indicating a large area of viable tissue. These regions showed akinesia on 2D echocardiography. The patient was treated conservatively, based on the comorbidity and poor target vessels for surgical
386
FDG4 revascularisation, and he subsequently died (sudden cardiac death) several months later. This observation on FDG SPECT underscores the unfavourable prognosis ofpatients with viable myocardium who are treated conservatively. In patients with viable myocardium and poor target vessels for revascularisation, newer techniques to promote angiogenesis such as laser revascularisation and injection of growth factors may become alternative treatment modalities in the near future. M
J.J. Bax. Leiden University Medical Centre, Department of Cardiology, Leiden. F.C. Visser. C.A. Visser. Free University Hospital, Amsterdam. Reference 1
Vanoverschelde JL, Wijns W, Borgers M, et al. Chronic myocardial hibernation in humans: from bench to bedside. Circulation 1997;95:1961-71.
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands.
Netherlands Heart Journal, Volume 9, Number 9, December 2001
\~ ~ ~ ~ ~ a4-so
Figure 1.
~~~~~~~~~~~~~~~~~~~
7-
12 7-78
" ~~~~~~~~~~~~66-72 Ei ~~~~~~~~~~~6066
_ _ _
SEPT
E
LAT
~~~~~~~~~~~~54-60 4
4
SEPT
LAT
3 6-42
_1W
7'TI-201
W12-1_
FD1
Tl-201 Prognostic value of viability assessment in chronic ischaemic LV dysfunction Combined assessment of myocardial perfusion with positron emission tomography (PET) or single photon emission computed tomography (SPECT), and glucose utilisation with F18-fluorodeoxyglucose (FDG) and PET or SPECT has allowed noninvasive assessment of myocardial viability.' In patients with ischaemic cardiomyopathy, the assessment of viability by FDG PET allows prediction ofimprovement ofleft ventricular function following revascularisation. In addition, the presence of viable myocardium on FDG PET is associated with a favourable long-term outcome after revascularisation.I This is in sharp contrast to the high event rate of patients with viable myocardium on FDG PET who are treated conservatively (medical therapy).'
These polar maps demonstrate the perfusion, assessed by thallium-201 SPECT (left), and the glucose utilisation, assessed by FDG SPECT during hyperinsulinaemic euglycaemic clamp (right), in a 69-yearold patient with ischaemic cardiomyopathy (old inferoseptal infarction, three-vessel coronary artery disease and a left ventricular ejection fraction of23%). He had extensive comorbidity: type II diabetes mellitus, impaired renal function and peripheral vascular disease. A large area ofhypoperfusion can be observed involving the posterolateral wall, inferior wall, and septum (left), with relatively preserved FDG uptake (right), indicating a large area of viable tissue. These regions showed akinesia on 2D echocardiography. The patient was treated conservatively, based on the comorbidity and poor target vessels for surgical
386
FDG4 revascularisation, and he subsequently died (sudden cardiac death) several months later. This observation on FDG SPECT underscores the unfavourable prognosis ofpatients with viable myocardium who are treated conservatively. In patients with viable myocardium and poor target vessels for revascularisation, newer techniques to promote angiogenesis such as laser revascularisation and injection of growth factors may become alternative treatment modalities in the near future. M
J.J. Bax. Leiden University Medical Centre, Department of Cardiology, Leiden. F.C. Visser. C.A. Visser. Free University Hospital, Amsterdam. Reference 1
Vanoverschelde JL, Wijns W, Borgers M, et al. Chronic myocardial hibernation in humans: from bench to bedside. Circulation 1997;95:1961-71.
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands.
Netherlands Heart Journal, Volume 9, Number 9, December 2001
