Abstract
PurposeTo evaluate myocardial viability assessment with hybrid 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MR) in predicting left ventricular (LV) wall motion recovery after percutaneous revascularisation of coronary chronic total occlusion (CTO).Methods and resultsForty-nine patients with CTO and corresponding wall motion abnormality (WMA) underwent [18F]FDG-PET/MR imaging for viability assessment prior to percutaneous revascularisation. After 3–6 months, 23 patients underwent follow-up MR to evaluate wall motion recovery. In total, 124 segments were assigned to the CTO territories, while 80 segments displayed impaired wall motion. Of these, 68% (54) were concordantly viable in PET and MR; conversely, only 2 segments (2%) were assessed non-viable by both modalities. However, 30% showed a discordant viability pattern, either PET non-viable/MR viable (3 segments, 4%) or PET viable/MR non-viable (21 segments, 26%), and the latter revealed a significant wall motion improvement at follow-up (p = 0.033). Combined imaging by [18F]FDG-PET/MR showed a fair accuracy in predicting myocardial recovery after CTO revascularisation (PET/MR area under ROC curve (AUC) = 0.72, p = 0.002), which was superior to LGE-MR (AUC = 0.66) and [18F]FDG-PET (AUC = 0.58) alone.ConclusionHybrid PET/MR imaging prior to CTO revascularisation predicts more accurately the recovery of dysfunctional myocardium than PET or MR alone. Its complementary information may identify regions of viable myocardium with increased potential for functional recovery.
Highlights
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology [1]
More than half of the PCI were performed in the right coronary artery (RCA, 56%), followed by left circumflex (LCx, 26%) and left anterior descending (LAD, 18%) coronary arteries
In the presence of wall motion abnormalities (WMA), viability imaging is recommended prior to CTO revascularisation by the 2018 ESC/EACTS Guidelines in order to determine the amount of viable myocardium and the likelihood to anticipate improvement of contractility [3]
Summary
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology [1]. Assessment of myocardial function, viability and ischemia, by means of a reliable diagnostic test, helps in predicting the outcome of the successful revascularisation of a CTO [4], such as functional improvement. Performing this additional risk assessment in the clinical routine allows an improved patient selection for the procedure [5]. A variety of diagnostic techniques have been introduced for the assessment of myocardial viability, allowing identification of ischaemic myocardium with potentially reversible contractile dysfunction. [18F]FDG-PET, the clinical “gold standard” for myocardial viability, identifies viable myocardium by non-invasive visualisation of glucose metabolism. Given its high spatial resolution, it allows the acquisition of both cardiac function and transmural definition of myocardial scarring, the latter using mainly late gadolinium enhancement (LGE) methods
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