Clinical InvestigationImaging and Diagnostic TestingIdentification and viability assessment of infarcted myocardium with late enhancement multidetector computed tomography: Comparison with thallium single photon emission computed tomography and echocardiography
Section snippets
Study patients
From January to December 2006, 155 patients referred to our cardiovascular center who had documented history of MI (>1 months and ≤6 months), did not receive primary or rescue angioplasty, and did not have valvular disease of more than moderate severity were evaluated to participate in this prospective study. Diagnosis of MI was defined by typical anginal pain lasting ≥30 minutes, biochemical evidence of peak creatine kinase ≥2 times of upper limit of normal with typical upsloping and
Clinical characteristics
During the period of the study, 116 patients who fit MDCT inclusion criteria underwent investigation. Fifteen patients were excluded because of image quality reasons (7 patients for MDCT images because of respiratory motion artifacts and 8 patients for DbE images because of limited echocardiographic windows with attenuation artifacts). Therefore, a total of 101 patients completed the study and further image analysis. All patients had MDCT-LE, Tl-SPECT, and DbE performed within 1 week after a
Discussion
This study shows that MDCT-LE can be accurate to identify the presence, location, and extent of infarcted myocardium and predict viability in selected patients after MI. From our enrolled patients with recent to chronic MI, approximately 75% fit MDCT inclusion criteria. Patient selection should be considered before applying this technique.
Conclusions
Multidetector computed tomography is accurate to identify the presence, location, and extent of infarcted myocardium, in comparison with Tl-SPECT and DbE. The segmental extent of MDCT-LE has good correlation with the magnitude of Tl-201 decreased uptake and can predict contractive reserve. It can serve as an alternative approach to assess viability, especially in selected patients with MI and LV dysfunction.
References (26)
- et al.
ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging)
J Am Coll Cardiol
(2003) - et al.
ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography)
J Am Coll Cardiol
(2003) Detection of coronary stenoses by multidetector computed tomography: it's all about resolution
J Am Coll Cardiol
(2004)- et al.
Safety and accuracy of multidetector row computed tomography for early assessment of residual stenosis of the infarct-related artery and the number of diseased vessels after acute myocardial infarction
Am Heart J
(2005) - et al.
Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced ECG-gated multidetector-row computed tomography
Clin Radiol
(2006) - et al.
Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging
J Am Coll Cardiol
(2005) - et al.
Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography
J Am Coll Cardiol
(1997) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study
Lancet
(2003) - et al.
The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine
J Nucl Cardiol
(2002)
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
Head-to-head comparison of exercise-redistribution-reinjection thallium single-photon emission computed tomography and low dose dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction
J Am Coll Cardiol
Reason for discrepancies in identifying myocardial viability by thallium-201 redistribution, magnetic resonance imaging, and dobutamine echocardiography
Am J Cardiol
Cited by (0)
This study was supported by the National Science Council, Taiwan (NSC 95-2314-B-075B-010-MY2, NSC 95-2314-B-010-100-MY2, NSC 95-2314-B-0758B-004) and Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (VGHKS 95-002&-003).