Functional and metabolic improvement after coronary intervention for non-viable myocardium detected by 18F fluorodeoxyglucose positron emission tomography.

Abstract

We report a case of a 64-year-old man suspected of myocardial infarction two months previously. Coronary angiography revealed total occlusion of the left anterior descending (LAD), and left ventriculography (LVG) showed remarkably reduced cardiac function and anterior dyskinesis. Electrocardiogram-gated thallium-201 Single Photon Emission Tomography (TL-SPECT) and 18F fluorodeoxyglucose positron emission tomography (FDG) were performed separately, and revealed large anterior myocardial infarction with markedly reduced tracer uptake, suggestive of non-viable myocardium. Percutaneous coronary intervention (PCI) was performed and stent was implanted successfully. Six months after PCI, LVG showed remarkable recovery in global function. Significant wall motion improvement and recovered glucose metabolism were observed in the infarcted myocardium despite having previously been diagnosed as lacking viability. <Learning Objectives: In patients with left ventricular dysfunction, revascularized myocardium can contribute to improve cardiac function and prognosis. This evidence was established for old, or chronic status of myocardial infarction which is defined as over one month from onset of acute myocardial infarction. In this case report, we suggest that it can be premature to determine myocardial viability using FDG for the patient with under pre-chronic status after myocardial infarction due to underestimation on myocardial FDG uptake.>.