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Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure

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Abstract

Purpose

The objective of this study was to assess the incremental value of myocardial wall motion and thickening compared with perfusion alone obtained from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in diagnosing myocardial viability in patients with ischemic heart failure.

Methods

Eighty-three consecutive patients with ischemic heart failure who underwent both 99mTc-MIBI gated SPECT MPI and 18F-FDG positron emission tomography (PET) myocardial metabolic imaging were retrospectively enrolled. SPECT/PET myocardial viability was defined as the reference standard. Segmental myocardial perfusion, wall motion, and thickening were measured by an automated algorithm from gated SPECT MPI. Univariate and stepwise multivariate analysis were conducted to establish an optimal multivariate model for predicting hibernating myocardium and scar.

Results

Among the 1411 segments evaluated, 774 segments had normal perfusion and 637 segments had decreased perfusion. The latter were classified by 18F-FDG PET into 338 hibernating segments and 299 scarred segments. The multivariate regression analysis showed that the model that combined myocardial perfusion uptake with wall motion and thickening scores had the optimal predictive efficiency to distinguish hibernating myocardium from scar in the segments with decreased perfusion. The model had the largest C-statistic (0.753 vs 0.666, P < 0.0001), and the global chi-square was increased from 53.281 to 111.234 when compared with perfusion alone (P < 0.001).

Conclusions

Assessment of myocardial wall motion and thickening in addition to conventional perfusion uptake in the segments with decreased perfusion enables better differentiation of hibernating myocardium from scar in patients with ischemic heart failure. Considering wide availability and high cost-effectiveness, regional myocardial function integrated with perfusion on gated SPECT MPI has great promise to become a clinical tool in the assessment of myocardial viability.

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Abbreviations

SPECT:

Single-photon emission computed tomography

PET:

Positron emission tomography

MPI:

Myocardial perfusion imaging

99mTc-MIBI:

99mTechnetium-sestamibi

18F-FDG:

18F-deoxyglucose

CAD:

Coronary artery disease

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

LVEF:

Left ventricular ejection fraction

WM:

Wall motion

WT:

Wall thickening

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Acknowledgments

This research was supported by grants from National Natural Science Foundation of China (81871381, PI: Yuetao Wang; 81901777, PI: Feifei Zhang; 81701737, PI: Jianfeng Wang; 81701734, PI: Xiaoliang Shao), the 5th phase “333 talent project” training funds of Jiangsu province (PI: Xiaoliang Shao), science and technology project for youth talents of Changzhou Health Committee (QN201920, PI: Feifei Zhang), the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou), and Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou).

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Correspondence to Weihua Zhou PhD or Yuetao Wang MD.

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Zhang, F., Wang, J., Shao, X. et al. Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure. J. Nucl. Cardiol. (2020). https://doi.org/10.1007/s12350-020-02040-4

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Keywords

  • Myocardial perfusion imaging
  • gated
  • wall motion
  • wall thickening
  • hibernating myocardium
  • ischemic heart failure