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. 2023 Sep;38(6):1288-1297.
doi: 10.1177/02676591221100739. Epub 2022 May 3.

The incremental value of myocardial viability, evaluated by 18F-fluorodeoxyglucose positron emission tomography, and cardiovascular magnetic resonance for mortality prediction in patients with previous myocardial infarction and symptomatic heart failure

Egle Kazakauskaite  1   2 , Donatas Vajauskas  1   2 , Lina Bardauskiene  1   2 , Rasa Ordiene  1   2 , Vytautas Zabiela  1   2 , Diana Zaliaduonyte  1   2 , Olivija Gustiene  1   2 , Tomas Lapinskas  1   2 , Renaldas Jurkevicius  1   2
Affiliations

The incremental value of myocardial viability, evaluated by 18F-fluorodeoxyglucose positron emission tomography, and cardiovascular magnetic resonance for mortality prediction in patients with previous myocardial infarction and symptomatic heart failure

Egle Kazakauskaite et al. Perfusion. 2023 Sep.

Abstract

Objectives: To find the imaging mortality predictors in patients with previous myocardial infarction (MI), symptomatic heart failure (HF), and reduced left ventricle (LV) ejection fraction (EF).

Methods: for the study 39 patients were selected prospectively with prior MI, symptomatic HF, and LVEF ≤40%. All patients underwent transthoracic echocardiography (TTE), single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), 18F-FDG positron emission tomography (FDG PET). 31 patients underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Patients were divided into two groups: 1 group - cardiac death; 2 group - no cardiac death. Myocardial scars were assessed on a 5-point-scale. Follow-up data was obtained.

Results: Imaging features disclosed significant difference (p < 0.05) of defect score (CMR and SPECT-PET), LV end-diastolic diameter (EDD) (TTE), LVEDD index (CMR), LV global longitudinal strain (CMR) and LV global circumferential strain (CMR) between the groups. Predictors of cardiac death were: LVEDD index (TTE) and LV global longitudinal strain. The cut-off values to predict cardiac death were: defect score (CMR) 25 (AUC, 79.5%; OR 1.8, 95% CI 1.2-2.7), SPECT-PET defect score 22 (AUC, 73.9%; OR 0.5, 95% CI 0.3-0.7), LVEDD (TTE) 58 mm (AUC, 88.4%; OR 23.6, 95% CI 2.6-217.7), LVEDDi 30 mm/m2 (TTE) (AUC, 73.6%; OR 22.0, 95% CI 1.9-251.5), LVEDDi 33.6 mm/m2 (CMR) (AUC, 73.6%; OR 22.0, 95% CI 1.9-251.5), LV global longitudinal strain -13.4 (AUC, 87.8%; OR 2.1, 95% CI 1.2-3.7) and LV global circumferential strain -16.3 (AUC, 76.1%; OR 1.9, 95% CI 1.2-3.0).

Conclusions: Imaging features, such as defect score (CMR) >25, SPECT-PET defect score >22, LVEDD (TTE) >58 mm, LVEDDi (TTE) >30 mm/m2, LVEDDi (CMR) >33.6 mm/m2, LV global longitudinal strain -13.4 and LV global circumferential strain -16.3, may increase sensitivity and specificity of FDG PET and LGE CMR predicting of late mortality.

Keywords: 18F-fluorodeoxyglucose positron emission tomography; late gadolinium enhancement; myocardial perfusion imaging; myocardial viability; strain-encoded imaging.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Myocardial viability evaluation by nuclear medicine imaging (SPECT and FDG-PET) and cardiovascular magnetic resonance (CMR with LGE and SENC). A- rest myocardial perfusion scintigraphy demonstrates perfusion defect in anterior and apical segments (SPECT defect score 24); B- FDG PET viability imaging represents the viable myocardium in the affected zone (PET defect score 10, PET reversibility score 14); C-D-E- CMR LGE images demonstrate transmural scar in anterior and apical LV segments (CMR defect score 27); F-D- CMR SENC imaging shows changes in myocardial deformation: Fglobal longitudinal strain -13.0, G- global circumferential strain -22.7.
Figure 2.
Figure 2.
Echocardiographic, nuclear medicine and cardiovascular magnetic resonance imaging predictors of cardiac death.
See this image and copyright information in PMC

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