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Head-to-head comparison of contrast-enhanced cardiovascular magnetic resonance and 201Thallium single photon emission computed tomography for prediction of reversible left ventricular dysfunction in chronic ischaemic heart disease

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Abstract

Delayed contrast-enhanced cardiovascular magnetic resonance (DE-CMR) allows assessment of reversibility of myocardial dysfunction. Comparative data to other modalities is scarce. Purpose of this study was to compare DE-CMR and 201Thallium single photon emission computed tomography (SPECT) for prediction of reversible left ventricular (LV) dysfunction in patients with chronic ischaemic heart disease. Fifty-four patients with LV dysfunction (mean ejection fraction (EF) 35 ± 8%) scheduled to undergo myocardial revascularization underwent DE-CMR and SPECT. Cine CMR was performed at baseline and at 8 months follow-up for assessment of regional and global myocardial function. Myocardial viability was determined by the segmental extent of delayed enhancement for DE-CMR, and by quantitative analysis of tracer uptake for SPECT, and was correlated to functional recovery after revascularization. After revascularization, 172 (49%) of 350 dysfunctional segments improved at follow-up cine CMR. Sensitivity and specificity for the prediction of functional recovery was 92 and 88%, respectively, for DE-CMR as compared to 86% (P = 0.4) and 56% (P = 0.001) for SPECT. Global LV function showed an increase of EF > 5% in 22 (41%) patients. The DE-CMR derived viability ratio (dysfunctional but viable myocardium) of 0.46 (sensitivity 91%, specificity 91%) was identified as predictor of increase in EF > 5% (P = 0.02), whereas the corresponding SPECT parameters were not predictive. DE-CMR compares favorably to SPECT for the prediction of regional and global improvement in LV function in the setting of chronic myocardial ischemia.

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Acknowledgment

This study was supported by the “ELAN-Programm der Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany” (M. R. and J. v. E.).

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Authors and Affiliations

  1. Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

    Matthias Regenfus, Christian Schlundt, Johannes von Erffa, Werner G. Daniel & Michael Schmid

  2. Siemens Medical Solutions, Erlangen, Germany

    Michaela Schmidt

  3. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

    Udo Reulbach

  4. Department of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

    Torsten Kuwert

Authors
  1. Matthias Regenfus
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  2. Christian Schlundt
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  3. Johannes von Erffa
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  4. Michaela Schmidt
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  5. Udo Reulbach
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  6. Torsten Kuwert
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  7. Werner G. Daniel
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  8. Michael Schmid
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Corresponding author

Correspondence to Matthias Regenfus.

Electronic supplementary material

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10554_2011_9941_MOESM1_ESM.avi

Video 1 Short axis cine CMR view of the patient from figure 1 (before coronary artery bypass grafting) showing akinesis in the inferior wall. CMR = cardiovascular magnetic resonance. Supplementary material 1 (AVI 837 kb)

10554_2011_9941_MOESM2_ESM.avi

Video 2 Short axis cine CMR view (corresponding slice position to video 1) of the patient from figure 1 (after coronary artery bypass grafting) showing improved wall thickening in the inferior and septal wall. CMR = cardiovascular magnetic resonance. Supplementary material 2 (AVI 1347 kb)

10554_2011_9941_MOESM3_ESM.avi

Video 3 Short axis cine CMR view of the patient from figure 2 (before coronary artery bypass grafting) showing akinesis in the inferior wall. CMR = cardiovascular magnetic resonance. Supplementary material 3 (AVI 654 kb)

10554_2011_9941_MOESM4_ESM.avi

Video 4 Short axis cine CMR view (corresponding slice position to video 3) of the patient from figure 2 (after coronary artery bypass grafting) showing no improvement of wall thickening in the inferior wall. CMR = cardiovascular magnetic resonance. Supplementary material 4 (AVI 692 kb)

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Regenfus, M., Schlundt, C., von Erffa, J. et al. Head-to-head comparison of contrast-enhanced cardiovascular magnetic resonance and 201Thallium single photon emission computed tomography for prediction of reversible left ventricular dysfunction in chronic ischaemic heart disease. Int J Cardiovasc Imaging 28, 1427–1434 (2012). https://doi.org/10.1007/s10554-011-9941-z

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  • DOI: https://doi.org/10.1007/s10554-011-9941-z

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