Comparative assessment of super(18)F-fluorodeoxyglucose PET and super(99m)Tc-tetrofosmin SPECT for the prediction of functional recovery in patients with reperfused acute myocardial infarction

• Published in: European journal of nuclear medicine and molecular imaging Vol. 33; no. 8; pp. 879 - 886
• Main Authors: Shirasaki, H, Nakano, A, Uzui, H, Yonekura, Y, Okazawa, H, Ueda, T, Lee, J-D
• Format: Journal Article
• Language: English
• Published: 01.08.2006
• ISSN: 1619-7070
• DOI: 10.1007/s00259-006-0071-0

Purpose: Although preserved glucose metabolism is considered to be a marker of myocardial viability in the chronic stage, it has not been fully elucidated whether this is also true with regard to reperfused acute myocardial infarction (AMI). The aim of this study was to compare the diagnostic performance of super(99m)Tc-tetrofosmin SPECT and super(18)F-fluorodeoxyglucose (FDG) PET for the prediction of functional recovery in reperfused AMI.Methods: The study population comprised 28 patients. Both tetrofosmin SPECT and FDG PET were performed in all 28 patients at ca. 2 weeks and in 23 at 6 months. The tetrofosmin and FDG findings in infarct-related segments were compared with the regional wall motion score assessed by left ventriculography over 6 months to determine the predictive value for functional recovery.Results: Of 120 infarct-related segments, 83 had preserved flow (tetrofosmin uptake greater than or equal to 50%) and 81 had preserved glucose metabolism (FDG uptake greater than or equal to 40%). The sensitivity and specificity of tetrofosmin SPECT for the prediction of functional recovery tended to be superior to those of FDG PET (90.0% and 72.5% vs 85.0% and 67.5%, respectively). Thirteen segments with preserved flow and decreased glucose metabolism demonstrated marked recovery of contractile function from 2.5 plus or minus 1.0 to 1.4 plus or minus 1.4 (p<0.01), with restoration of glucose metabolism at 6 months. In contrast, 11 segments with decreased flow and preserved glucose metabolism demonstrated incomplete functional improvement from 3.0 plus or minus 0.8 to 2.2 plus or minus 1.2.Conclusion: In the subacute phase, preserved myocardial blood flow is more reliable than glucose metabolism in predicting functional recovery in reperfused myocardium.