Myocardiun viability assessed by delayed contrast-enhanced magnetic resonance imaging in patients with severe ischemic heart failure: A comparison with thallium SPECT and dobutamine echocardiography
Journal
World Heart Journal
Journal Volume
1
Journal Issue
1
Pages
57-68
Date Issued
2008
Author(s)
Huang P.-J.
Wang Y.-T.
KAI-YUAN TZEN
Abstract
Purpose: Functional recovery of ischemic cardiomyopathy depends on accurate identification of viable myocardium. We evaluated the value of delayed contrast-enhanced magnetic resonance imaging (MRI) in the assessment of myocardial viability. Materials and Methods: Forty patients with significant coronary artery disease and severe left ventricular (LV) dysfunction received delayed contrast-enhanced MRI and 201Tl single-photon emission computed tomography (SPECT) within one month. Ten of them received simultaneous 201Tl SPECT and dobutamine stress echocardiography (DSE). Three imaging modalities were compared based on a standardized 17-segment model. Improved regional wall thickening on follow-up MRI was used as an index of functional recovery in patients received revascularization. Results: Of 680 segments, MRI hyperenhancement showed positive correlation with 201Tl reduction (r =0.61, p < 0.0001). The viability concordance was 75.3% between DSE and MRI, 80.5% between 201Tl SPECT and MRI, and 66.5% among all tests. Contrast-enhanced MRI detected more myocardial viability than 201Tl SPECT, especially in the inferior wall and apex (p < 0.0001). Eight patients underwent revascularization. Comparing with functional recovery in the follow-up results, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of delayed contrast-enhanced MRI were 64%, 95%, 24%, 62% and 77%, respectively. For 201Tl SPECT, these values were 55%, 75%, 29%, 58% and 54%, respectively. Areas under the ROC curves by MRI and 201Tl SPECT were 0.59 ± 0.04, 0.52 ± 0.05, respectively (p=0.07). Of 16 segments viable on MRI but nonviable on 201Tl SPECT, 12 (75%) recovered function after revascularization, while only one of 3 segments classified as nonviable on MRI but viable on 201Tl SPECT recovered function (p < 0.05). Of 10 segments classified as scar by both tests, none recovered function after revascularization. Conclusion: Delayed contrast-enhanced MRI detects viability better than 201Tl SPECT, especially in the inferior wall and apex. Myocardial viability detected by MRI may predict functional recovery after revascularization in ischemic cardiomyopathy, even in patients with severe LV dysfunction. ? 2008 Nova Science Publishers, Inc.
SDGs
Other Subjects
dipyridamole; dobutamine; gadolinium pentetate; thallium 201; adult; aged; article; cardiomyopathy; clinical article; contrast enhancement; controlled study; coronary artery bypass surgery; coronary artery disease; diagnostic accuracy; disease severity; female; follow up; heart failure; heart left ventricle failure; heart muscle perfusion; heart muscle revascularization; human; male; nuclear magnetic resonance imaging; percutaneous coronary intervention; prediction; sensitivity and specificity; single photon emission computer tomography; stress echocardiography
Type
journal article