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1 CREATIS, UMR-CNRS 5515, LYON, France; CERMEP, LYON, France
2 CREATIS, UMR-CNRS 5515, LYON, France; CERMEP, LYON, France; Lyon1, Claude-Bernard University, LYON, France
3 Hopital Cardio-vasculaire et Pneumologique Louis Pradel, LYON, France
4 Lyon1, Claude-Bernard University, LYON, France; Hopital Cardio-vasculaire et Pneumologique Louis Pradel, LYON, France
5 CREATIS, UMR-CNRS 5515, LYON, France; Lyon1, Claude-Bernard University, LYON, France; Hopital Cardio-vasculaire et Pneumologique Louis Pradel, LYON, France
* To whom correspondence should be addressed. E-mail: croisille{at}creatis.insa-lyon.fr.
Background: The impact of blood flow reductions on the intramyocardial inotropic reserve has not been yet established in coronary artery disease (CAD). We therefore evaluated in severe CAD the relationship between positron emission tomography (PET)-patterns of perfusion and glucose uptake and corresponding tagged-magnetic resonance imaging (tagged-MRI) values of midmyocardial strains under low dose dobutamine. Methods and Results: Eighteen patients underwent tagged-MRI (at rest/dobutamine) and H2 15O/18FDG-PET. Regional midmyocardial circumferential shortening (Ecc) and PET-patterns (normal, match viable, mismatch viable, infarcted) were assessed in 3 tagged-MRI/PET short-axis slices. Regional Ecc at rest correlated with both, perfusion (r=0.49) and glucose uptake (r=0.58). The presence of inotropic reserve was similar in normal, match viable and infarcted (~40% of regions vs 52% in mismatch viable; p<0.05), but the extent of the increase after dobutamine was lower in infarcted regions (p=0.06). Within each PET-pattern, regions were grouped according to their Ecc values at rest in 3 categories (high, intermediate and low contractile performance). In mismatch viable (hibernation) the inotropic reserve was similar among the three categories, but in the other PET-patterns the presence and the extent of the inotropic reserve was higher in those regions with lowest Ecc (without significant differences in perfusion). Conclusions: In severe CAD, the presence of inotropic reserve assessed by midmyocardial changes under dobutamine does not relate to resting perfusion. At a similar level of perfusion, the presence of inotropic reserve is inversely related to contractile performance at rest, but our results suggest that it may not be true for hibernating myocardium.
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