J Cardiovasc Interv.  2022 Jul;1(3):139-144. 10.54912/jci.2022.0001.

Clinical Implication of Hybrid PET/ MRI for Patients With Chronic Total Occlusion and Severe Left Ventricular Dysfunction

• Park JI
• Kong E
• Kim U

• KMID: 2561252
• DOI: http://doi.org/10.54912/jci.2022.0001

Abstract

The role of assessment for myocardial viability and long-term outcomes still remains controversial in patients with ischemic cardiomyopathy. Here, we report a case of detecting viable myocardium by hybrid positron emission tomography/magnetic resonance imaging (PET/MRI), successfully treated a patient with chronic total occlusion (CTO) and severe left ventricular (LV) dysfunction and finally normalized LV systolic function during follow-up. A 53-year-old man was presented at our emergency department with aggravated dyspnea. Transthoracic echocardiography (TTE) revealed severe LV dysfunction (LV ejection fraction [LVEF] = 17%). Coronary angiography revealed 3-vessel disease with 2-vessel CTO, located at the right coronary artery and left anterior descending artery. The hybrid PET/MRI showed viable myocardium with less than 50% of late gadolinium enhancement and sufficient fluorodeoxyglucose uptake. With guideline-directed medical treatment including angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist percutaneous coronary intervention was performed and led to complete revascularization. Six months after revascularization, symptom of patient was improved and the results of TTE showed no regional wall motional abnormality and normalized LVEF (55%). In conclusion, hybrid PET/MRI is important assessment tool to detect myocardial viability and predict prognosis in patients with multi-vessels CTO and severe LV dysfunction.

Keyword

Positron emission tomography; Viability; Coronary occlusion; Left ventricular dysfunction