Online myocardial viability assessment in the catheterization laboratory via NOGA electroanatomic mapping - Quantitative comparison with thallium-201uptake

Background-The aim of this prospective study was to investigate the concord ance between quantitative resting Tl-201 uptake as an established myocardia l viability index and the electrical activity of the heart, determined by N OGA nonfluoroscopic electroanatomic mapping. Methods and Results-The myocardial resting and late resting thallium uptake s of 384 myocardial segments from 32 patients (27 males aged 65 +/- 8 years ) with previous myocardial infarction and chronic stable angina were compar ed with unipolar voltage potentials and local shortening of the left ventri cle as assessed by electroanatomic mapping. The quantitative thallium uptak e data were analyzed by polar map analysis by division into 12 comparable m yocardial segments, as represented in electroanatomic mapping images. Unipo lar voltage potentials exhibited a significant logarithmic correlation with both resting and late resting thallium uptake (attenuation corrected: r = 0.660 and r = 0.744; non-attenuation corrected: r = 0.623 and r = 0.721). R eceiver operator characteristic analyses revealed unipolar voltage cutoff p oints of 12.0 mV (predictive accuracy 0.853, P < 0.001; sensitivity/specifi city 81%) for normal myocardium and 6.4 mV (predictive accuracy 0.901, P < 0.001; sensitivity/specificity 82%) for nonviable myocardium assessed by at tenuation-corrected Tl-201 late resting images and of 12.7 mV (predictive a ccuracy 0.822, P < 0.001; sensitivity/specificity 75%) and 6.5 mV (predicti ve accuracy 0.808, P < 0.001; sensitivity/specificity 73%) for non-attenuat ion-corrected late resting Tl-201 images. Conclusions-These results indicate that the unipolar voltage potentials obt ained by electroanatomic mapping correlate well with standard quantitative late resting Tl-201 imaging for the evaluation of myocardial viability; thu s, NOGA endocardial mapping provides useful "online" data at the time of ca theterization, especially when information from other methods for viability assessment is unavailable.