Comparison of radionuclide myocardial perfusion/metabolic imaging with cardiac magnetic resonance for assessing myocardial viability in ischemic heart failure
Objective To compare the capability of radionuclide myocardial perfusion/metabolic imaging(hereinafter referred to as 18F-FDG PET)and cardiac magnetic resonance(CMR)in the assessment of myocardial viability among patients with ischemic heart failure.Methods A total of 285 consecutive patients with ischemic heart failure combined with cardiac dysfunction who underwent 18F-FDG PET and CMR imaging simultaneously(within a month)at Fuwai Hospital,Chinese Academy of Medical Sciences from March 2016 to December 2019 were included in the retrospective analysis.The patients comprised 260 males and 25 females,aged(57.8±10.0)years.The 17-segment method was used to compare the agreement and differences of 18F-FDG PET and CMR in the identification of viable myocardium and infarcted myocardium in each myocardial segment.Spearman correlation coefficient and Kendall's tau-b correlation coefficient were used to analyze the correlation between the two methods in the identification of different myocardial viabilities.The Bland-Altman method was used to evaluate the diagnostic agreement between the two methods in assessing infarcted myocardium.Results Of the 285 patients with a total of 4 845 myocardial segments,3 376(69.7％)myocardial segments with wall motion abnormality on 18F-FDG PET were included in the analysis.The total content of infarcted myocardium measured through 18F-FDG PET and CMR was 17.6％±13.0％and 19.2％±13.4％,respectively,and a significant correlation existed between them(r=0.67,P＜0.001).By contrast,18F-FDG PET may underestimate the content of infarcted myocardium compared with CMR(The 95％CI of the total difference in infarcted myocardium content was-12.7％-27.8％,and the mean difference was 7.5％).Among the 697 segments with motion abnormality detected through CMR as transmural infarctions,most(90.4％,630/697)showed transmural or non-transmural infarctions detected through 18F-FDG PET,showing a high agreement between the two methods.Among the 1 371 segments detected as non-transmural infarctions through CMR,as many as 686(50.0％)did not show infarct changes on 18F-FDG PET.At the individual level,no significant correlation(r=-0.09,P=0.12)exists between the total infarcted myocardium content detected through CMR and the total hibernating myocardium content detected through 18F-FDG PET in each patient.Among the 1 371 segments detected as non-transmural infarctions through CMR,838(61.1％)had hibernating myocardium detected through 18F-FDG PET.Moreover,among the 697 segments detected as transmural infarctions through CMR,286(41.0％)had hibernating myocardium detected through 18F-FDG PET.Segments with non-transmural infarctions detected through CMR contained more hibernating myocardium than those with transmural infarctions(61.1％vs.41.0％,x2=66.207,P＜0.001).Conclusions 18F-FDG PET and CMR have their strengths in assessing myocardial viability in patients with ischemic heart failure.CMR is superior to 18F-FDG PET in terms of identifying infarcted myocardium,whereas 18F-FDG PET is more sensitive in detecting viable myocardium with the ability to distinguish hibernating myocardium.Combining 18F-FDG PET and CMR will provide more comprehensive information on myocardial viability.
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