P. Perronefilardi et al., CLINICAL-SIGNIFICANCE OF REDUCED REGIONAL MYOCARDIAL GLUCOSE-UPTAKE IN REGIONS WITH NORMAL BLOOD-FLOW IN PATIENTS WITH CHRONIC CORONARY-ARTERY DISEASE, Journal of the American College of Cardiology, 23(3), 1994, pp. 608-616
Objectives. The objective of this study was to assess the clinical sig
nificance of reduced regional fluorine-18 F-18- fluorodeoxyglucose upt
ake with normal flow in patients with chronic coronary artery disease.
Background. In patients with ischemic left ventricular dysfunction, F
-18-fluorodeoxyglucose uptake may be reduced in some myocardial region
s despite normal how. The significance of this finding is unclear and
has not been investigated systematically. Methods. Twenty-three patien
ts with coronary artery disease and impaired ventricular function (mea
n ejection fraction [+/- SD] 28 +/- 10%) underwent positron emission t
omography with F-18-fluorodeoxyglucose and oxygen 15-labeled water at
rest, exercise thallium-201 tomographic imaging with rest reinjection
and gated magnetic resonance imaging to measure end-diastolic wall thi
ckness and systolic wall thickening. Results. Of 168 regions with norm
al flow (greater than or equal to 0.7 ml/g per min), 125 (74%) had nor
mal F-18-fluorodeoxyglucose uptake (98 +/- 1O%), and the remaining 43
(26%) showed moderately reduced F-18-fluorodeoxyglucose uptake (69 +/-
8%). Systolic wall thickening was absent at rest in 14% of regions wi
th normal F-18-fluorodeoxyglucose uptake compared with 32% of regions
with reduced F-18-fluorodeoxyglucose uptake (p < 0.01). Reversible tha
llium abnormalities were observed in 45 (36%) of 125 regions with norm
al F-18-fluorodeoxyglucose uptake compared with 27 (63%) of 43 regions
with reduced F-18-fluorodeoxyglucose uptake (p < 0.01). This differen
ce was accounted for by a higher proportion of partially reversible de
fects in regions with reduced F-18-fluorodeoxyglucose uptake compared
with regions with normal F-18-fluorodeoxyglucose uptake (42% vs. 18%,
respectively, p < 0.01). Conclusions. Thus, regions with moderately re
duced F-18-fluorodeoxyglucose uptake with normal flow occur commonly i
n patients with ischemic left ventricular dysfunction. The majority of
these regions show impaired systolic function at rest and exercise in
duced thallium abnormalities that are only partially reversible. These
observations suggest that such regions represent an admixture of fibr
otic and reversibly ischemic myocardium.