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Myocardial ¹⁸F-FDG Uptake After Exercise-Induced Myocardial Ischemia in Patients with Coronary Artery Disease

¹ Department of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; ² Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and ³ Drexel University College of Medicine, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Zuo-Xiang He, Department of Nuclear Medicine, Medical Imaging Center, Fu Wai Hospital, 167 Bei Li Shi Lu, Beijing 100037, China. E-mail: zuoxianghe{at}hotmail.com; zxhe{at}btamail.net.cn

We have recently demonstrated the potential of ¹⁸F-FDG as an imaging marker of myocardial ischemia if injected at peak exercise. However, how long increased ¹⁸F-FDG uptake can be observed after an episode of exercise-induced myocardial ischemia is not known. We performed the current study to determine whether increased regional myocardial ¹⁸F-FDG uptake at exercise in patients with coronary artery disease (CAD) persists on rest imaging (24 h later), after an episode of exercise-induced myocardial ischemia. Methods: Twenty-four patients with suspected CAD underwent exercise ^99mTc-sestamibi and ¹⁸F-FDG imaging. Repeated ¹⁸F-FDG imaging was performed 24 h after exercise imaging, after an injection of a second dose of ¹⁸F-FDG at rest in 20 patients. Perfusion imaging with ^99mTc-sestamibi was simultaneously performed with ¹⁸F-FDG imaging. All patients underwent coronary angiography. Results: Eighteen patients had greater than or equal to 70% luminal narrowing of 1 or more coronary vessels. Fifteen patients (83%) showed increased regional ¹⁸F-FDG uptake on exercise imaging, but only 11 patients (61%) had perfusion abnormalities. Of these 15 patients with increased regional ¹⁸F-FDG uptake on exercise imaging, 8 (53%) had no discernible ¹⁸F-FDG uptake, 5 (33%) had decreased ¹⁸F-FDG uptake, and only 2 (13%) had persistent ¹⁸F-FDG uptake on rest ¹⁸F-FDG images. The summed ¹⁸F-FDG uptake score significantly decreased, from 14.4 ± 10.3 at exercise to 6.7 ± 9.2 at rest (P = 0.01). Patients with persistent ¹⁸F-FDG uptake at rest had more ¹⁸F-FDG uptake and lower peak rate–pressure product at exercise, compared with patients with no residual ¹⁸F-FDG uptake at rest. Conclusion: Exercise-induced regional myocardial ¹⁸F-FDG uptake is highly specific and sensitive for exercise-induced myocardial ischemia. Regional myocardial ¹⁸F-FDG uptake may persist 24 h after an episode of exercise-induced myocardial ischemia in some patients.

Key Words: myocardium • ischemia • coronary artery disease • exercise • rest • ¹⁸F-FDG

^* Contributed equally to this work.

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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