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Electromechanical Properties of Perfusion/Metabolism Mismatch: Comparison of Nonfluoroscopic Electroanatomic Mapping with ¹⁸F-FDG PET

¹ Department of Cardiology, Medical University of Vienna, Vienna, Austria
² Technische Universität München, Munich, Germany
³ Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria

View larger version (69K): [in a new window]   FIGURE 1. Short-axis views of 18F-FDG PET (A) and 201Tl SPECT scintigraphy (B) of 50-y-old patient with significant stenosis of circumflex artery with moderately decreased global LV function. Perfusion/metabolism mismatch is present in midlateral wall with reduced 201Tl uptake and increased 18F-FDG uptake. Electrical activity (unipolar voltage) was nearly normal in all segments (C), whereas LLS showed decreased values in midlateral wall (D).

View larger version (86K): [in a new window]   FIGURE 2. Polar map analysis of 18F-FDG PET metabolic imaging (A) and 201Tl perfusion imaging (B) and NOGA mapping (C, unipolar voltage; D, LLS) of patient with severe stenosis of diagonal branch of left anterior descending artery with perfusion/metabolism mismatch in basal and middle anterior and anterolateral walls with unipolar voltage values within normal range and reduced LLS values.

View larger version (34K): [in a new window]   FIGURE 3. Linear correlation between UpV by NOGA mapping and normalized 201Tl and 18F-FDG uptake in all myocardial segments (A, 201Tl: P < 0.0001, r = 0.41, r2 = 0.17, SEE = 4.1; B, 18F-FDG: P < 0.0001, r = 0.45, r2 = 0.20, SEE = 4.0), in hypoperfused segments (C, 201Tl: P < 0.001, r = 0.38, r2 = 0.14, SEE = 3.2; D, 18F-FDG: P < 0.0001, r = 0.6, r2 = 0.36, SEE = 2.8), and in segments with perfusion/metabolism mismatch (E, 201Tl: P = NS, r = 0.2, r2 = 0.04, SEE = 3.4; F, 18F-FDG: P < 0.05, r = 0.45, r2 = 0.21, SEE = 3.1).

View larger version (10K): [in a new window]   FIGURE 4. (A) Determination of threshold value of unipolar endocardial voltage for identification of PET viable myocardium with sensitivity and specificity of 85% based on threshold of 5.2 mV. (B) ROC curves of UpV and LLS for differentiation between PET viable and PET nonviable myocardium with area under the curve of 0.9 ± 0.03 and 0.69 ± 0.06, respectively.