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
Key result
ce-CMR matches PET/SPECT PPV for functional recovery but yields a higher ~93% NPV.
- n=29
Why the study?
The study aimed to compare contrast-enhanced cardiovascular magnetic resonance and combined PET/SPECT imaging protocols for predicting functional recovery after revascularization in chronic ischaemic cardiomyopathy.
Does contrast-enhanced cardiovascular magnetic resonance (ce-CMR) compare favorably to combined PET/SPECT for predicting functional recovery after revascularization in patients with chronic ischaemic cardiomyopathy?
Key Points
- To compare contrast-enhanced cardiovascular magnetic resonance (ce-CMR) with combined PET/SPECT imaging for predicting regional and global functional recovery after revascularization in patients with chronic ischaemic cardiomyopathy.
- Evaluated 29 patients with ischaemic cardiomyopathy (mean ejection fraction 32 ± 10%) using baseline ce-CMR and combined 18F-FDG PET and 99mTc-sestamibi SPECT.
- Quantitated the segmental extent of hyperenhancement (SEH) on ce-CMR and defined viability categories on PET/SPECT using a quantitative protocol.
- Assessed global and regional myocardial functional improvement via cine CMR at baseline and 6 months following revascularization.
- Sensitivity and specificity for predicting functional recovery at follow-up were 97% and 68% for ce-CMR versus 87% and 76% for PET/SPECT.
- Positive predictive value was 73% for both modalities, whereas ce-CMR demonstrated a higher negative predictive value than PET/SPECT (93% vs. 77%).
- Both imaging techniques demonstrated a similar yield in predicting global functional recovery.
Study Design
Type
Observational (n=29)
Structured PICO
Does contrast-enhanced cardiovascular magnetic resonance (ce-CMR) compare favorably to combined PET/SPECT for predicting functional recovery after revascularization in patients with chronic ischaemic cardiomyopathy?
P
Population
29 patients with ischaemic cardiomyopathy (mean ejection fraction 32%) undergoing revascularization, followed for 6 months.
E
Exposure
Contrast-enhanced cardiovascular magnetic resonance (ce-CMR)
C
Comparator
Combined (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and (99m)Tc-sestamibi single-photon emission computed tomography (SPECT) protocol
O
Outcome
Prediction of functional recovery after revascularization at 6 months follow-up, assessed by cine CMRsurrogate
ce-CMR is comparable to PET/SPECT for predicting functional recovery after revascularization but may be superior for identifying segments unlikely to recover.
Implication
ce-CMR performs comparably to PET/SPECT for predicting regional/global recovery post-revascularization; small Level 4 study leaves open any superiority in ruling out recovery.
Abstract
AIMS: The aim of the study was to compare, in patients with chronic ischaemic cardiomyopathy, contrast-enhanced cardiovascular magnetic resonance (ce-CMR) imaging and a combined (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and (99m)Tc-sestamibi single-photon emission computed tomography (SPECT) protocols for the prediction of functional recovery after revascularization, as assessed by cine CMR. METHODS AND RESULTS: Twenty-nine patients with ischaemic cardiomyopathy (ejection fraction 32 +/- 10%) were investigated with ce-CMR and PET/SPECT. For the assessment of global and regional functions, cine CMR was performed at baseline and at 6 months follow-up. For ce-CMR, the segmental extent of hyperenhancement (SEH) was quantitated, and for PET/SPECT, different viability categories were defined according to a validated quantitative protocol. Functional improvement was related to the SEH by ce-CMR, as well as to the viability categories by PET/SPECT. Sensitivity and specificity for the prediction of functional recovery at follow-up was 97 and 68% for ce-CMR and 87 and 76% for PET/SPECT. The positive predictive value was identical for both techniques (73%). However, ce-CMR achieved a higher negative predictive value (93 vs. 77%, respectively), indicating that ce-CMR may be superior to PET/SPECT for the identification of segments unlikely to recover function after revascularization. Both methods had a similar yield in the prediction of global functional improvement. CONCLUSION: ce-CMR is comparable with a PET/SPECT imaging protocol for the prediction of regional and global functional improvement after revascularization. However, ce-CMR may be superior to nuclear imaging for the identification of segments that are unlikely to recover function at follow-up.
Discussion
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Cite This Study
Kühl et al. (2006) conducted an observational in chronic ischaemic cardiomyopathy (n=29). Contrast-enhanced cardiovascular magnetic resonance (ce-CMR) vs. Combined 18F-FDG PET and 99mTc-sestamibi SPECT was evaluated on Prediction of functional recovery after revascularization. Contrast-enhanced CMR and PET/SPECT had similar positive predictive value (73%) for functional recovery after revascularization, but ce-CMR achieved a higher negative predictive value (93% vs 77%).