Purpose: The aim of the study was to evaluate a novel polar map of myocardial viability obtained by gated SPECT imaging to predict functional recovery after revascularization in patients with ischaemic left ventricular (LV) dysfunction. Methods: The study group comprised 17 patients (15 men, mean age 58∈±∈9 years) with ischaemic LV dysfunction (ejection fraction ≥40%) who underwent nitrate-enhanced gated SPECT before and 6 months after coronary revascularization. A parametric image of viable myocardium (VIA) was obtained using a semiautomated method to subtract the point-to-point motion polar map from the perfusion polar map. A parametric image of segments with functional recovery (REC) was obtained by subtracting the baseline motion polar map from the motion polar map after revascularization. Results: Of the total 340 segments, 248 (73%) were considered viable on the basis of the VIA map. After revascularization, of 248 dysfunctional viable segments 186 (75%) showed an improvement in LV function. An increase in LV ejection fraction (from 30∈±∈10% to 42∈±∈11%, p∈

*** IBB - CNR ***

Department of Imaging, A.O.R.N. S.G. Moscati, Avellino, Italy

Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy

Institute of Diagnostic and Nuclear Development, SDN Foundation, Naples, Italy

Department of Cardiology and Heart Surgery, A.O.R.N. S.G. Moscati, Avellino, Italy

Remme, W.J., Swedberg, K., Guidelines for the diagnosis and treatment of chronic heart failure (2001) Eur Heart J, 22, pp. 1527-1560. , Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. 10.1053/euhj.2001.2783 1:STN:280: DC%2BD3Mvks1CitA%3D%3D 1149298

Cowie, M.R., Wood, D.A., Coats, A.J., Thompson, S.G., Poole-Wilson, P.A., Suresh, V., Incidence and aetiology of heart failure: A population-based study (1999) Eur Heart J, 20, pp. 421-428. , 10.1053/euhj.1998.1280 1:STN:280:DyaK1M3ivVemuw%3D%3D 10213345

Bax, J.J., Poldermans, D., Elhendy, A., Boersma, E., Rahimtoola, S.H., Sensitivity, specificity and predictive accuracies of various non-invasive techniques for detecting hibernating myocardium (2001) Curr Probl Cardiol, 26, pp. 147-186. , 10.1067/mcd.2001.109973 1:STN:280:DC%2BD3M7os1SisQ%3D%3D 11276916

Underwood, S.R., Bax, J.J., Vom Dahl, J., Henein, M.J., Van Rossum, A.C., Schwarz, E.R., Imaging techniques for the assessment of myocardial hibernation. Report of a study group of the European Society of Cardiology (2004) Eur Heart J, 25, pp. 815-836. , 10.1016/j.ehj.2004.03.012 15140530

Patel, R.A., Beller, G.A., Prognostic role of single-photon emission computed tomography (SPECT) imaging in myocardial viability (2006) Curr Opin Cardiol, 21, pp. 457-463. , 10.1097/01.hco.0000240582.83967.d8 16900008

Evangelista, L., Acampa, W., Petretta, M., Ferro, A., Ricci, F., Luongo, L., Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction (2009) J Nucl Cardiol, 16, pp. 38-44. , 10.1007/s12350-008-9004-6 19152127

Hesse, B., Tägil, K., Cuocolo, A., Anagnostopoulos, C., Bardiés, M., Bax, J., EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology (2005) Eur J Nucl Med Mol Imaging, 32, pp. 855-897. , 10.1007/s00259-005-1779-y 1:STN:280:DC%2BD2Mzpt1Kjsg%3D%3D 15909197

Fleiss, J.L., (1981) Statistical Methods for Rates and Proportions, pp. 217-225. , 2 Wiley New York

Bax, J.J., Ansalone, G., Breithardt, O.A., Derumeaux, G., Leclercq, C., Schalij, M.J., Echocardiographic evaluation of cardiac resynchronization therapy: Ready for routine clinical use? A critical appraisal (2004) J Am Coll Cardiol, 44, pp. 1-9. , 10.1016/j.jacc.2004.02.055 15234396

Patterson, R.E., Pilcher, W.C., Assessing myocardial viability to help select patients for revascularization to improve left ventricular dysfunction due to coronary artery disease (1995) Semin Thorac Cardiovasc Surg, 7, pp. 214-226. , 1:STN:280:DyaK287hvVSiug%3D%3D 8590746

Allman, K.C., Shaw, L.J., Hachamovitch, R., Udelson, J.E., Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: A meta-analysis (2002) J Am Coll Cardiol, 39, pp. 1151-1158. , 10.1016/S0735-1097(02)01726-6 11923039

Bax, J.J., Van Der Wall, E.E., Haebison, M., Radionuclide techniques for the assessment of myocardial viability and hibernation (2004) Heart, 90 (SUPPL. V), pp. 26-33. , 10.1136/hrt.2002.007575

Cuocolo, A., Pace, L., Ricciardelli, B., Chiariello, M., Trimarco, B., Salvatore, M., Identification of viable myocardium in patients with coronary artery disease: Comparison of thallium-201 scintigraphy with reinjection and technetium-99m methoxyisobutyl isonitrile (1992) J Nucl Med, 33, pp. 505-511. , 1:CAS:528:DyaK38XktVensrk%3D 1552332

He, Z.X., Darcourt, J., Guignier, A., Ferrari, E., Bussière, F., Baudouy, M., Nitrates improve detection of ischaemic but viable myocardium by thallium-201 reinjection SPECT (1993) J Nucl Med, 34, pp. 1472-1477. , 1:STN:280:DyaK3szlvF2mtA%3D%3D 8355066

Bisi, G., Sciagrà, R., Santoro, G.M., Rossi, V., Fazzini, P.F., Technetium-99m-sestamibi imaging with nitrate infusion to detect viable hibernating myocardium and predict postrevascularisation recovery (1995) J Nucl Med, 36, pp. 1994-2000. , 1:STN:280:DyaK28%2FkvFSqtw%3D%3D 7472587

Maurea, S., Cuocolo, A., Soricelli, A., Castelli, L., Nappi, A., Squame, F., Enhanced detection of viable myocardium by technetium-99m-MIBI imaging after nitrate administration in chronic coronary artery disease (1995) J Nucl Med, 36, pp. 1945-1952. , 1:STN:280:DyaK28%2FkvFSrug%3D%3D 7472580

Sciagrà, R., Bisi, G., Santoro, G.M., Agnolucci, M., Zoccarato, O., Fazzini, P.F., Influence of the assessment of defect severity and intravenous nitrate administration during tracer injection on the detection of viable hibernating myocardium with data-based quantitative technetium 99m-labelled sestamibi single photon emission computed tomography (1996) J Nucl Cardiol, 3, pp. 221-230. , 10.1016/S1071-3581(96)90036-7 8805742

Remme, W. J., Swedberg, K., Guidelines for the diagnosis and treatment of chronic heart failure (2001) Eur Heart J, 22, pp. 1527-1560. , Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. 10. 1053/euhj. 2001. 2783 1: STN: 280: DC%2BD3Mvks1CitA%3D%3D 1149298

Cowie, M. R., Wood, D. A., Coats, A. J., Thompson, S. G., Poole-Wilson, P. A., Suresh, V., Incidence and aetiology of heart failure: A population-based study (1999) Eur Heart J, 20, pp. 421-428. , 10. 1053/euhj. 1998. 1280 1: STN: 280: DyaK1M3ivVemuw%3D%3D 10213345

Bax, J. J., Poldermans, D., Elhendy, A., Boersma, E., Rahimtoola, S. H., Sensitivity, specificity and predictive accuracies of various non-invasive techniques for detecting hibernating myocardium (2001) Curr Probl Cardiol, 26, pp. 147-186. , 10. 1067/mcd. 2001. 109973 1: STN: 280: DC%2BD3M7os1SisQ%3D%3D 11276916

Underwood, S. R., Bax, J. J., Vom Dahl, J., Henein, M. J., Van Rossum, A. C., Schwarz, E. R., Imaging techniques for the assessment of myocardial hibernation. Report of a study group of the European Society of Cardiology (2004) Eur Heart J, 25, pp. 815-836. , 10. 1016/j. ehj. 2004. 03. 012 15140530

Patel, R. A., Beller, G. A., Prognostic role of single-photon emission computed tomography (SPECT) imaging in myocardial viability (2006) Curr Opin Cardiol, 21, pp. 457-463. , 10. 1097/01. hco. 0000240582. 83967. d8 16900008

Hesse, B., T gil, K., Cuocolo, A., Anagnostopoulos, C., Bardi s, M., Bax, J., EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology (2005) Eur J Nucl Med Mol Imaging, 32, pp. 855-897. , 10. 1007/s00259-005-1779-y 1: STN: 280: DC%2BD2Mzpt1Kjsg%3D%3D 15909197

Fleiss, J. L., (1981) Statistical Methods for Rates and Proportions, pp. 217-225. , 2 Wiley New York

Bax, J. J., Ansalone, G., Breithardt, O. A., Derumeaux, G., Leclercq, C., Schalij, M. J., Echocardiographic evaluation of cardiac resynchronization therapy: Ready for routine clinical use? A critical appraisal (2004) J Am Coll Cardiol, 44, pp. 1-9. , 10. 1016/j. jacc. 2004. 02. 055 15234396

Patterson, R. E., Pilcher, W. C., Assessing myocardial viability to help select patients for revascularization to improve left ventricular dysfunction due to coronary artery disease (1995) Semin Thorac Cardiovasc Surg, 7, pp. 214-226. , 1: STN: 280: DyaK287hvVSiug%3D%3D 8590746

Allman, K. C., Shaw, L. J., Hachamovitch, R., Udelson, J. E., Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: A meta-analysis (2002) J Am Coll Cardiol, 39, pp. 1151-1158. , 10. 1016/S0735-1097 (02) 01726-6 11923039

Bax, J. J., Van Der Wall, E. E., Haebison, M., Radionuclide techniques for the assessment of myocardial viability and hibernation (2004) Heart, 90 (SUPPL. V), pp. 26-33. , 10. 1136/hrt. 2002. 007575

He, Z. X., Darcourt, J., Guignier, A., Ferrari, E., Bussi re, F., Baudouy, M., Nitrates improve detection of ischaemic but viable myocardium by thallium-201 reinjection SPECT (1993) J Nucl Med, 34, pp. 1472-1477. , 1: STN: 280: DyaK3szlvF2mtA%3D%3D 8355066

Bisi, G., Sciagr, R., Santoro, G. M., Rossi, V., Fazzini, P. F., Technetium-99m-sestamibi imaging with nitrate infusion to detect viable hibernating myocardium and predict postrevascularisation recovery (1995) J Nucl Med, 36, pp. 1994-2000. , 1: STN: 280: DyaK28%2FkvFSqtw%3D%3D 7472587

Sciagr, R., Bisi, G., Santoro, G. M., Agnolucci, M., Zoccarato, O., Fazzini, P. F., Influence of the assessment of defect severity and intravenous nitrate administration during tracer injection on the detection of viable hibernating myocardium with data-based quantitative technetium 99m-labelled sestamibi single photon emission computed tomography (1996) J Nucl Cardiol, 3, pp. 221-230. , 10. 1016/S1071-3581 (96) 90036-7 8805742