PET abnormalities in patients with nonischemic cardiomyopathy
Section snippets
Study Group
This was a retrospective study, and data were extracted from a database that was approved by the Institutional Review Board of the Cleveland Clinic Foundation. The requirement for obtaining informed consent was waived. Forty-four patients with chronic New York Heart Association class III–IV symptoms (duration >3 months), referred for heart failure evaluation were being considered for cardiac surgical procedures; hence we sought to determine the extent of viable myocardium, defined as myocardium
Results
The clinical characteristics of these patients are described in Table 1. Forty-four patients, mean age 56.8 ± 13 (range 20–75) years, 65% male, were studied. Forty-one (93%) had idiopathic DCM, 15/44 (34%) had atrial fibrillation, and 7/44 (16%) had a history of thromboembolism (4 left ventricular thrombus, 2 transient ischemic attack, and 1 pulmonary embolus).
PET imaging revealed matched Rubidium and FDG defects in 40 of 44 (91%), suggesting the presence of myocardial scar (nonviability). Mean
Discussion
Coronary arteriography is often deferred in favor of less-invasive tests, including echocardiography, nuclear studies, and PET imaging. PET imaging has the advantage that it can evaluate regional metabolic activity in addition to regional perfusion. Pharmacologic stressors can be given to evaluate for ischemia.
The data shown here indicate that regional wall motion and metabolic abnormalities are commonly seen on echocardiography, radionuclide ventriculography, and PET. Those with the longest
Conclusions
Scar seen with PET in patients with DCM is misleading and not indicative of coronary artery disease. Therefore, coronary arteriography is usually required to rule out obstructive coronary disease in patients with DCM because of the limitations of noninvasive imaging modalities.
QRS duration correlates with perfusion and metabolic defects (scar) by PET and may reflect poor prognosis. Effective treatment may reduce these abnormalities. The broad QRS complex seen in DCM may be to a greater or
Acknowledgments
The authors wish to acknowledge the secretarial assistance of Ms. Susan Federico in the preparation of this manuscript.
References (24)
- et al.
Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis
J Am Coll Cardiol
(2002) - et al.
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)
J Am Coll Cardiol
(2001) - et al.
The incidence of scintigraphically viable and nonviable tissue by rubidium-82 and fluorine-18-fluorodeoxyglucose positron emission tomographic imaging in patients with prior infarction and left ventricular dysfunction
J Nucl Cardiol
(1996) - et al.
Dobutamine stress echocardiography: detection of coronary artery disease in patients with dilated cardiomyopathy
J Am Coll Cardiol
(1994) - et al.
The value of echocardiographic regional wall motion abnormalities in detecting coronary artery disease in patients with or without a dilated left ventricle
Am Heart J
(1985) - et al.
Heterogeneity of ventricular function and myocardial oxidative metabolism in nonischemic dilated cardiomyopathy
J Am Coll Cardiol
(1995) - et al.
Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy
J Am Coll Cardiol
(2000) - et al.
Prognostic utility of myocardial blood flow assessed by N-13 ammonia positron emission tomography in patients with idiopathic dilated cardiomyopathy
Am J Cardiol
(1999) - et al.
Chronic heart failure in the United States: a manifestation of coronary artery disease
Circulation
(1998) - et al.
Radionuclide assessment of regional differences in left ventricular wall motion and myocardial perfusion in idiopathic dilated cardiomyopathy
Eur Heart J
(1993)
Congestive cardiomyopathy with segmental wall motion abnormalities and a non-uniform pattern of fibrosis
Cathet Cardiovasc Diagn
Dobutamine stress echocardiography and thallium-201 SPECT for detecting ischaemic dilated cardiomyopathy in patients with heart failure
Eur J Echocardiogr
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