Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography

Abdallah AlMohammad; Murdoch Y. Norton; Andrew E. Welch; Peter F. Sharp; Stephen Walton

doi:10.1136/openhrt-2016-000581

Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography

Abdallah AlMohammad, Murdoch Y. Norton, Andrew E. Welch, Peter F. Sharp, Stephen Walton

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Abstract

Objective Perfusion-metabolism mismatch pattern on positron emission tomography (PET) predicts hibernating myocardium. We assess the ECG-gated metabolic PET as a surrogate for the perfusion-metabolism mismatch pattern on PET imaging.

Methods 13 N-Ammonia (NH 3) and 18 F-fluorodeoxyglucose (FDG) are respectively perfusion and metabolism PET tracers. We used ECG gating to acquire FDG-PET to collect wall thickening (mechanical) data. These allow detection of metabolic activity in regions with reduced contraction (metabolism-mechanical mismatch pattern). We had two data sets on each patient: Perfusion-metabolism and metabolism-mechanical data sets. We tested the hypothesis that metabolism-mechanical pattern on PET could predict perfusion-metabolism mismatch pattern.

Results We studied 55 patients (48 males), mean age 62 years. All were in sinus rhythm, and had impaired left ventricular contraction. Perfusion-metabolism mismatch pattern was found in 26 patients. Metabolism-mechanical mismatch pattern was found in 25 patients. The results were concordant in 52 patients (95%). As a surrogate for perfusion-metabolism mismatch pattern, demonstration of metabolism-mechanical mismatch pattern is highly sensitive (92%) and specific (97%). In this cohort, the positive and negative predictive accuracy of the new method are 96% and 93%, respectively.

Conclusion Metabolism-mechanical mismatch pattern could predict perfusion-metabolism mismatch pattern in patients with myocardial viability criteria on PET. Prospective validation against the gold standard of improved myocardial contraction after revascularisation is needed.

Original language	English
Article number	e000581
Pages (from-to)	1-6
Number of pages	6
Journal	Open Heart
Volume	4
Issue number	2
DOIs	https://doi.org/10.1136/openhrt-2016-000581
Publication status	Published - 28 Jul 2017

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10.1136/openhrt-2016-000581Licence: CC BY-NC

Gated metabolic myocardial imaging, a surrogate for dual perfusionmetabolism imaging by positron emission tomography
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Final published version, 554 KBLicence: CC BY-NC

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AlMohammad, A., Norton, M. Y., Welch, A. E., Sharp, P. F., & Walton, S. (2017). Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography. Open Heart, 4(2), 1-6. [e000581]. https://doi.org/10.1136/openhrt-2016-000581

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title = "Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography",

abstract = "Objective Perfusion-metabolism mismatch pattern on positron emission tomography (PET) predicts hibernating myocardium. We assess the ECG-gated metabolic PET as a surrogate for the perfusion-metabolism mismatch pattern on PET imaging. Methods 13 N-Ammonia (NH 3) and 18 F-fluorodeoxyglucose (FDG) are respectively perfusion and metabolism PET tracers. We used ECG gating to acquire FDG-PET to collect wall thickening (mechanical) data. These allow detection of metabolic activity in regions with reduced contraction (metabolism-mechanical mismatch pattern). We had two data sets on each patient: Perfusion-metabolism and metabolism-mechanical data sets. We tested the hypothesis that metabolism-mechanical pattern on PET could predict perfusion-metabolism mismatch pattern. Results We studied 55 patients (48 males), mean age 62 years. All were in sinus rhythm, and had impaired left ventricular contraction. Perfusion-metabolism mismatch pattern was found in 26 patients. Metabolism-mechanical mismatch pattern was found in 25 patients. The results were concordant in 52 patients (95%). As a surrogate for perfusion-metabolism mismatch pattern, demonstration of metabolism-mechanical mismatch pattern is highly sensitive (92%) and specific (97%). In this cohort, the positive and negative predictive accuracy of the new method are 96% and 93%, respectively. Conclusion Metabolism-mechanical mismatch pattern could predict perfusion-metabolism mismatch pattern in patients with myocardial viability criteria on PET. Prospective validation against the gold standard of improved myocardial contraction after revascularisation is needed.",

author = "Abdallah AlMohammad and Norton, {Murdoch Y.} and Welch, {Andrew E.} and Sharp, {Peter F.} and Stephen Walton",

note = "Acknowledgments The authors are grateful for the help from Dr H Ali and Dr A Dawson. Funding: This study was performed using a research grant from the Aberdeen Royal Hospitals Trust's Endowment Fund, with further support from the Department of Medical Physics at the University of Aberdeen, for which the authors express their gratitude.",

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AU - Norton, Murdoch Y.

AU - Welch, Andrew E.

AU - Sharp, Peter F.

AU - Walton, Stephen

N1 - Acknowledgments The authors are grateful for the help from Dr H Ali and Dr A Dawson. Funding: This study was performed using a research grant from the Aberdeen Royal Hospitals Trust's Endowment Fund, with further support from the Department of Medical Physics at the University of Aberdeen, for which the authors express their gratitude.

PY - 2017/7/28

Y1 - 2017/7/28

N2 - Objective Perfusion-metabolism mismatch pattern on positron emission tomography (PET) predicts hibernating myocardium. We assess the ECG-gated metabolic PET as a surrogate for the perfusion-metabolism mismatch pattern on PET imaging. Methods 13 N-Ammonia (NH 3) and 18 F-fluorodeoxyglucose (FDG) are respectively perfusion and metabolism PET tracers. We used ECG gating to acquire FDG-PET to collect wall thickening (mechanical) data. These allow detection of metabolic activity in regions with reduced contraction (metabolism-mechanical mismatch pattern). We had two data sets on each patient: Perfusion-metabolism and metabolism-mechanical data sets. We tested the hypothesis that metabolism-mechanical pattern on PET could predict perfusion-metabolism mismatch pattern. Results We studied 55 patients (48 males), mean age 62 years. All were in sinus rhythm, and had impaired left ventricular contraction. Perfusion-metabolism mismatch pattern was found in 26 patients. Metabolism-mechanical mismatch pattern was found in 25 patients. The results were concordant in 52 patients (95%). As a surrogate for perfusion-metabolism mismatch pattern, demonstration of metabolism-mechanical mismatch pattern is highly sensitive (92%) and specific (97%). In this cohort, the positive and negative predictive accuracy of the new method are 96% and 93%, respectively. Conclusion Metabolism-mechanical mismatch pattern could predict perfusion-metabolism mismatch pattern in patients with myocardial viability criteria on PET. Prospective validation against the gold standard of improved myocardial contraction after revascularisation is needed.

AB - Objective Perfusion-metabolism mismatch pattern on positron emission tomography (PET) predicts hibernating myocardium. We assess the ECG-gated metabolic PET as a surrogate for the perfusion-metabolism mismatch pattern on PET imaging. Methods 13 N-Ammonia (NH 3) and 18 F-fluorodeoxyglucose (FDG) are respectively perfusion and metabolism PET tracers. We used ECG gating to acquire FDG-PET to collect wall thickening (mechanical) data. These allow detection of metabolic activity in regions with reduced contraction (metabolism-mechanical mismatch pattern). We had two data sets on each patient: Perfusion-metabolism and metabolism-mechanical data sets. We tested the hypothesis that metabolism-mechanical pattern on PET could predict perfusion-metabolism mismatch pattern. Results We studied 55 patients (48 males), mean age 62 years. All were in sinus rhythm, and had impaired left ventricular contraction. Perfusion-metabolism mismatch pattern was found in 26 patients. Metabolism-mechanical mismatch pattern was found in 25 patients. The results were concordant in 52 patients (95%). As a surrogate for perfusion-metabolism mismatch pattern, demonstration of metabolism-mechanical mismatch pattern is highly sensitive (92%) and specific (97%). In this cohort, the positive and negative predictive accuracy of the new method are 96% and 93%, respectively. Conclusion Metabolism-mechanical mismatch pattern could predict perfusion-metabolism mismatch pattern in patients with myocardial viability criteria on PET. Prospective validation against the gold standard of improved myocardial contraction after revascularisation is needed.

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