Skip to main content
Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2005 Sep;13(9):305-306, 307-310, 311.

Myocardial viability assessment: poor correlation between electromechanical cardiac mapping and positron emission tomography in severe coronary artery disease

PA van der Vleuten, ES Tan, RA Tio, F Zijlstra
PMCID: PMC2497261  PMID: 25696517

Abstract

Background

An intracardial electromechanical mapping system has recently been introduced which offers the ability to perform on-line myocardial viability assessment in the catheterisation laboratory. Only a small number of studies have been performed to validate this potentially very useful technique.

Aim

We sought to assess the correlation between viability assessment performed with both positron emission tomography (PET) and electromechanical cardiac mapping (EMM) in patients suffering from severe coronary artery disease, since PET is considered the golden standard in myocardial viability assessment.

Methods

Patients undergoing both EMM and PET analysis were systematically scanned for viability assessment. EMM analysis was performed for both linear local shortening and unipolar voltage. PET analysis consisted of dipyridamole stress and fluoro-deoxy-d-glucose (FDG) measurements. All data were converted to nine-segment bull's-eye maps to allow comparison. One single operator analysed all the data, blinded for clinical status.

Results

34 patients suffering from severe coronary artery disease underwent both PET and EMM analysis. In total 253 EMM segments had more than four contact points and could be used for analysis. Unipolar voltage showed a trend towards lower values in infarcted segments; however, linear local shortening did not show any correlation.

Conclusion

In this study viability assessment by EMM did not correspond with PET analysis. Although the advantage of having some form of online myocardial assessment is evident, operators should bare in mind that the quantitative EMM measurements are not an absolute substitute for nuclear imaging.

Keywords: electromechanical cardiac mapping, positron emission tomography, viability assessment

Full text

PDF
305

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baer F. M., Voth E., Deutsch H. J., Schneider C. A., Horst M., de Vivie E. R., Schicha H., Erdmann E., Sechtem U. Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization. J Am Coll Cardiol. 1996 Jul;28(1):60–69. doi: 10.1016/0735-1097(96)00106-4. [DOI] [PubMed] [Google Scholar]
  2. Bax J. J., Cornel J. H., Visser F. C., Fioretti P. M., van Lingen A., Huitink J. M., Kamp O., Nijland F., Roelandt J. R., Visser C. A. Prediction of improvement of contractile function in patients with ischemic ventricular dysfunction after revascularization by fluorine-18 fluorodeoxyglucose single-photon emission computed tomography. J Am Coll Cardiol. 1997 Aug;30(2):377–383. doi: 10.1016/s0735-1097(97)00174-5. [DOI] [PubMed] [Google Scholar]
  3. Bax J. J., Wijns W., Cornel J. H., Visser F. C., Boersma E., Fioretti P. M. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol. 1997 Nov 15;30(6):1451–1460. doi: 10.1016/s0735-1097(97)00352-5. [DOI] [PubMed] [Google Scholar]
  4. Bonow R. O. Identification of viable myocardium. Circulation. 1996 Dec 1;94(11):2674–2680. doi: 10.1161/01.cir.94.11.2674. [DOI] [PubMed] [Google Scholar]
  5. Bøtker H. E., Lassen J. F., Hermansen F., Wiggers H., Søgaard P., Kim W. Y., Bøttcher M., Thuesen L., Pedersen A. K. Electromechanical mapping for detection of myocardial viability in patients with ischemic cardiomyopathy. Circulation. 2001 Mar 27;103(12):1631–1637. doi: 10.1161/01.cir.103.12.1631. [DOI] [PubMed] [Google Scholar]
  6. Di Carli M. F., Asgarzadie F., Schelbert H. R., Brunken R. C., Laks H., Phelps M. E., Maddahi J. Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy. Circulation. 1995 Dec 15;92(12):3436–3444. doi: 10.1161/01.cir.92.12.3436. [DOI] [PubMed] [Google Scholar]
  7. Flamm Scott D. High-dose dobutamine stress cardiac magnetic resonance imaging--has its time come? Eur Heart J. 2004 Jul;25(14):1183–1184. doi: 10.1016/j.ehj.2004.05.020. [DOI] [PubMed] [Google Scholar]
  8. Fuchs S., Kornowski R., Shiran A., Pierre A., Ellahham S., Leon M. B. Electromechanical characterization of myocardial hibernation in a pig model. Coron Artery Dis. 1999 May;10(3):195–198. doi: 10.1097/00019501-199905000-00009. [DOI] [PubMed] [Google Scholar]
  9. Gepstein L., Goldin A., Lessick J., Hayam G., Shpun S., Schwartz Y., Hakim G., Shofty R., Turgeman A., Kirshenbaum D. Electromechanical characterization of chronic myocardial infarction in the canine coronary occlusion model. Circulation. 1998 Nov 10;98(19):2055–2064. doi: 10.1161/01.cir.98.19.2055. [DOI] [PubMed] [Google Scholar]
  10. Graf Senta, Gyöngyösi Mariann, Khorsand Aliasghar, Nekolla Stephan G., Pirich Christian, Kletter Kurt, Dudczak Robert, Glogar Dietmar, Porenta Gerold, Sochor Heinz. Electromechanical properties of perfusion/metabolism mismatch: comparison of nonfluoroscopic electroanatomic mapping with 18F-FDG PET. J Nucl Med. 2004 Oct;45(10):1611–1618. [PubMed] [Google Scholar]
  11. Kornowski R., Hong M. K., Leon M. B. Comparison between left ventricular electromechanical mapping and radionuclide perfusion imaging for detection of myocardial viability. Circulation. 1998 Nov 3;98(18):1837–1841. doi: 10.1161/01.cir.98.18.1837. [DOI] [PubMed] [Google Scholar]
  12. McGhie A. I., Weyman A. Searching for hibernating myocardium. Time to reevaluate investigative strategies? Circulation. 1996 Dec 1;94(11):2685–2688. doi: 10.1161/01.cir.94.11.2685. [DOI] [PubMed] [Google Scholar]
  13. Wiggers Henrik, Bøtker Hans Erik, Søgaard Peter, Kaltoft Anne, Hermansen Flemming, Kim Won Yong, Krusell Lars, Thuesen Leif. Electromechanical mapping versus positron emission tomography and single photon emission computed tomography for the detection of myocardial viability in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2003 Mar 5;41(5):843–848. doi: 10.1016/s0735-1097(02)02961-3. [DOI] [PubMed] [Google Scholar]

Articles from Netherlands Heart Journal are provided here courtesy of Springer

RESOURCES