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H R Schelbert

Publications and source records attributed to H R Schelbert.

224 records · Page 13Linked to original sources
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Relation of myocardial perfusion at rest and during pharmacologic stress to the PET patterns of tissue viability in patients with severe left ventricular dysfunction.

BACKGROUND: Stress perfusion imaging can assess effectively the amount of jeopardized myocardium, but its use for identifying underperfused but viable myocardium has yielded variable results. We evaluated the relation between measurements of myocardial perfusion at rest and during pharmacologic stress and the patterns of tissue viability as determined by positron emission tomographic (PET) imaging. METHODS AND RESULTS: We studied 33 patients with coronary artery disease and left ventricular (LV) dysfunction (LV ejection fraction, 30%+/-8%). PET imaging was used to evaluate regional myocardial perfusion at rest and during pharmacologic stress with [13N]-ammonia as a flow tracer, and to delineate patterns of tissue viability (i.e., perfusion-metabolism mismatch or match) using [18F]-deoxyglucose (FDG). We analyzed 429 myocardial regions, of which 229 were dysfunctional at rest. Of these, 30 had normal perfusion and 199 were hypoperfused. A severe resting defect (deficit >40% below normal) predicted lack of significant tissue viability; 31 of 35 regions (89%) had a PET match pattern denoting transmural fibrosis. Although regions with mild or moderate resting defects (deficit <40% below normal) showed evidence of metabolic activity, perfusion measurements alone failed to identify regions with PET mismatch (reflecting hibernating myocardium). Reversible stress defects were observed with slightly higher frequency in regions with a PET mismatch (10 of 37) than in those with a PET match (36 of 162) pattern of viability. A reversible stress defect was a specific (78%) marker, but was a relatively insensitive marker (27%) of viable myocardium as defined by the PET mismatch pattern. CONCLUSIONS: In patients with LV dysfunction, the severity of regional contractile abnormalities correlates with the severity of flow deficit at rest. Severe reductions in resting blood flow in these dysfunctional regions identify predominantly nonviable myocardium that is unlikely to have improved function after revascularization. Although dysfunctional myocardium with mild to moderate flow reductions contains variable amounts of viable tissue (as assessed by FDG uptake), flow measurements alone do not distinguish between regions with PET mismatch (potentially reversible dysfunction) and PET match (irreversible dysfunction). The presence of an irreversible defect on stress imaging is a relatively specific (78%) marker of PET match, whereas a reversible stress defect is a rather insensitive (27%) marker of viability, as defined by the PET mismatch pattern.

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Considerations of 201T1 as a myocardial radionuclide imaging agent in man.

Recent reports have suggested the use of intravenous 201T1 (thallium-201) for myocardial imaging with the gamma scintillation camera. In order to better appreciate the possible utility of this agent in humans we examined its distribution and kinetics in 13 patients and in six mongrel dogs, three with experimental coronary artery occlusion. In addition, 201T1 was compared to 86Rb (rubidium-86) in 84 rats. In the rat heart, the concentration of 201T1 was 30% higher than that of 86Rb ten minutes after injection. Moreover, myocardium-to-blood ratios for 201T1 averaged 51:1, but only 32:1 for 86Rb ten minutes after administration. In the dog heart, the distribution of 201T1 paralleled that of radioiodinated (131I) albumin particles injected into the left atrium and, thus, appears to be related to regional blood flow. Its concentration in ischemic regions decreased to 32.3% of the normally perfused myocardium. In the patients with a recent or old myocardial infarction, areas of decreased 201T1 uptake were easily identified and corresponded in location to that by ECG. Repeat scans 24 hours after the initial injection showed a significant retention of 201T1 by the myocardium. 201T1 blood levels in humans 15 minutes after injection were low (averaging 1.06% +/- 0.41% SD of the total dose per liter) and these levels decreased with a biological half-life of 3.1 +/- 0.7 days. Twenty-four hour urinary excretion rates ranged from 0.6 to 6.5% of the total dose and appeared related to urinary flow and the concentation of 201T1 in blood. Because of the higher target to background ratios, 201T1 compares favorably with radioactive rubidium. 201T1 in diagnostic doses remained without detectable adverse effects and appears promising as an agent for visualizing abnormal regional myocardial perfusion in patients with coronary artery disease.

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