Abstract
Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow-up (>5%—responders). MRI with ≤5 segments with DE/wall thickness ratio (DEWTR) ≥50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of ≤2 segments with the DEWTR ≥75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT < 16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preoperative number of segments with the DE/wall thickness ratio of ≥50 and ≥75% obtained by MRI, was found to be a better predictor of left ventricular reverse remodeling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improvement at 24 months after CABG.
Similar content being viewed by others
References
Bax JJ, van der Wall EE, Harbinson M (2004) Radionuclide techniques for the assessment of myocardial viability and hibernation. Heart 90(suppl 5):26–33
Pagley PR, Beller GA, Watson DD, Gimple LW, Ragosta M (1997) Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability. Circulation 96:793–800
Bax JJ, Poldermans D, Elhendy A, Cornel JH, Boersma E, Rambaldi R, Roelandt JR, Fioretti PM (1999) Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography. J Am Coll Cardiol 34:163–169
Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M (1983) Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 68(4):785–795
Brundage BH, Massie BM, Botvinick EH (1984) Improved regional ventricular function after successful surgical revascularization. J Am Coll Cardiol 3(4):902–908
Allman KC, Shaw LJ, Hachamovitch R, Udelson JE (2002) Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 39(7):1159–1162
Bax JJ, Visser FC, Poldermans D, Elhendy A, Cornel JH, Boersma E, van Lingen A, Fioretti PM, Visser CA (2001) Time course of functional recovery of stunned and hibernating segments after surgical revascularization. Circulation 104:314–318
Beek AM, Kühl HP, Bondarenko O, Twisk JW, Hofman MB, van Dockum WG, Visser CA, van Rossum AC (2003) Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol 42(5):895–901
Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343(20):1445–1453
Selvanayagam JB, Kardos A, Francis JM, Wiesmann F, Petersen SE, Taggart DP, Neubauer S (2004) Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation 110(12):1535–1541
Krittayaphong R, Laksanabunsong P, Maneesai A, Saiviroonporn P, Udompunturak S, Chaithiraphan V (2008) Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery. J Cardiovasc Magn Reson 10(1):41
Bondarenko O, Beek AM, Nijveldt R, McCann GP, van Dockum WG, Hofman MB, Twisk JW, Visser CA, van Rossum AC (2007) Functional outcome after revascularization in patients with chronic ischemic heart disease: a quantitative late gadolinium enhancement CMR study evaluating transmural scar extent, wall thickness and periprocedural necrosis. J Cardiovasc Magn Reson 9(5):815–821
Paeng JC, Lee DS, Kang WJ, Lee BI, Kim KB, Chung JK, Lee MC (2005) Time course of functional recovery after coronary artery bypass grafting surgery according to the preoperative reversibility of perfusion impairment on myocardial SPECT. Eur J Nucl Med Mol Imaging 32(1):70–74
Ragosta M, Beller GA, Watson DD, Kaul S, Gimple LW (1993) Quantitative planar rest-redistribution 201Tl imaging in detection of myocardial viability and prediction of improvement in left ventricular function after coronary bypass surgery in patients with severely depressed left ventricular function. Circulation 87(5):1630–1641
Shan K, Constantine G, Sivananthan M, Flamm SD (2004) Role of cardiac magnetic resonance imaging in the assessment of myocardial viability. Circulation 109(11):1328–1334
Hausmann H, Meyer R, Siniawski H, Pregla R, Gutberlet M, Amthauer H, Felix R, Hetzer R (2004) Factors exercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting. Eur J Cardiothorac Surg 26(1):89–95
Gutberlet M, Fröhlich M, Mehl S, Amthauer H, Hausmann H, Meyer R, Siniawski H, Ruf J, Plotkin M, Denecke T, Schnackenburg B, Hetzer R, Felix R (2005) Myocardial viability assessment in patients with highly impaired left ventricular function: comparison of delayed enhancement, dobutamine stress MRI, end-diastolic wall thickness, and TI201-SPECT with functional recovery after revascularization. Eur Radiol 15(5):872–880
Kitagawa K, Sakuma H, Hirano T, Okamoto S, Makino K, Takeda K (2003) Acute myocardial infarction: myocardial viability assessment in patients early thereafter comparison of contrast-enhanced MR imaging with resting (201)Tl SPECT. Radiology 226(1):138–144
Kühl HP, Lipke CS, Krombach GA, Katoh M, Battenberg TF, Nowak B, Heussen N, Buecker A, Schaefer WM (2006) Assessment of reversible myocardial dysfunction in chronic ischaemic heart disease: comparison of contrast-enhanced cardiovascular magnetic resonance and a combined positron emission tomography-single photon emission computed tomography imaging protocol. Eur Heart J 27(7):846–853
Schvartzman PR, Srichai MB, Grimm RA, Obuchowski NA, Hammer DF, McCarthy PM, Kasper JM, White RD (2003) Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction. Am Heart J 146(3):535–541
Wu YW, Tadamura E, Yamamuro M, Kanao S, Marui A, Tanabara K, Komeda M, Togashi K (2007) Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease. J Nucl Med 48(11):1789
Bondarenko O, Beek AM, Twisk JW, Visser CA, van Rossum AC (2008) Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study. Eur Heart J 29(16):2000–2005
Schinkel AF, Poldermans D, Rizzello V, Vanoverschelde JL, Elhendy A, Boersma E, Roelandt JR, Bax JJ (2004) Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization? J Thorac Cardiovasc Surg 127:385–390
Bax JJ, Visser FC, Poldermans D, Elhendy A, Cornel JH, Boersma E, Valkema R, Van Lingen A, Fioretti PM, Visser CA (2001) Relationship between preoperative viability and postoperative improvement in LVEF and heart failure symptoms. J Nucl Med 42:79–86
Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS, American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the american heart association. Circulation 105:539–542
Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S, Granger CB, Michelson EL, Wang D, Pocock S, Pfeffer MA, Candesartan in Heart Failure Reduction in Mortality (CHARM) Investigators (2005) Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 112:3738–3744
Kwon DH, Halley CM, Carrigan TP, Zysek V, Popovic ZB, Setser R, Schoenhagen P, Starling RC, Flamm SD, Desai MY (2009) Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function. A delayed hyperenhancement cardiac magnetic resonance study. J Am Coll Cardiol Cardiovas Imaging 2(1):34–44
Roes SD, Kelle S, Kaandorp TA, Kokocinski T, Poldermans D, Lamb HJ, Boersma E, van der Wall EE, Fleck E, de Roos A, Nagel E, Bax JJ (2007) Comparison of myocardial infarct size assessed with contrast-enhanced magnetic resonance imaging and left ventricular function and volumes to predict mortality in patients with healed myocardial infarction. Am J Cardiol 100(6):930–936
Bax JJ, Schinkel AF, Boersma E, Elhendy A, Rizzello V, Maat A, Roelandt JR, van der Wall EE, Poldermans D (2004) Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation 110(11 suppl 1):II18–II22
Wu YW, Tadamura E, Kanao S, Yamamuro M, Marui A, Komeda M, Toma M, Kimura T, Togashi K (2007) Myocardial viability by contrast-enhanced cardiovascular magnetic resonance in patients with coronary artery disease: comparison with gated single-photon emission tomography and FDG position emission tomography. Int J Cardiovasc Imaging 23(6):757–765
Chareonthaitawee P, Gersh BJ, Araoz PA, Gibbons RJ (2005) Revascularization in severe left ventricular dysfunction: the role of viability testing. J Am Coll Cardiol 46:567–574
Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA (1994) Management of heart failure: the role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. JAMA 272:1528–1534
Senior R, Kaul S, Lahiri A (1999) Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure. J Am Coll Cardiol 33(7):1848–1854
Hutyra M, Skála T, Kamínek M, Horák D, Lukl J (2008) The importance of determining the viability of the myocardium prior to revascularisation in patients with ischaemic cardiomyopathy and left ventricular systolic dysfunction. Vnitř Lék 54(4):273–279
Demir H, Tan YZ, Kozdag G, Isgoren S, Anik Y, Ural D, Demirci A, Berk F (2007) Comparison of gated SPECT, echocardiography and cardiac magnetic resonance imaging for the assessment of left ventricular ejection fraction and volumes. Ann Saudi Med 27(6):415–420
Stegger L, Lipke CS, Kies P, Nowak B, Schober O, Buell U, Schäfers M, Schaefer WM (2007) Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: validation of an elastic surface model approach in comparison to cardiac magnetic resonance imaging, 4D-MSPECT and QGS. Eur J Nucl Med Mol Imaging 34(6):900–909
Faber TL, Vansant JP, Pettigrew RI, Galt JR, Blais M, Chatzimavroudis G, Cooke CD, Folks RD, Waldrop SM, Gurtler-Krawczynska E, Wittry MD, Garcia EV (2001) Evaluation of left ventricular endocardial volumes and ejection fractions computed from gated perfusion SPECT with magnetic resonance imaging: comparison of two methods. J Nucl Cardiol 8(6):645–651
Bax JJ, Lamb H, Dibbets P, Pelikan H, Boersma E, Viergever EP, Germano G, Vliegen HW, de Roos A, Pauwels EK, Van der Wall EE (2000) Comparison of gated single-photon emission computed tomography with magnetic resonance imaging for evaluation of left ventricular function in ischemic cardiomyopathy. Am J Cardiol 86(12):1299–1305
Bavelaar-Croon CD, Kayser HW, van der Wall EE, de Roos A, Dibbets-Schneider P, Pauwels EK, Germano G, Atsma DE (2000) Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values. Radiology 217(2):572–575
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Skala, T., Hutyra, M., Vaclavik, J. et al. Prediction of long-term reverse left ventricular remodeling after revascularization or medical treatment in patients with ischemic cardiomyopathy: a comparative study between SPECT and MRI. Int J Cardiovasc Imaging 27, 343–353 (2011). https://doi.org/10.1007/s10554-010-9677-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-010-9677-1