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Objective <p>Accurate assessment of myocardial viability is essential in ischemic cardiomyopathy, yet resting FDG PET/CT may underestimate viable tissue in segments with impaired perfusion or ischemia induced insulin resistance. This study evaluated whether adenosine stimulated FDG PET/CT enhances the detection of viable myocardium in patients with ischemic cardiomyopathy for revascularization, compared with resting FDG PET/CT.</p> Methods <p>Twenty-one nondiabetic patients with ischemic cardiomyopathy (LVEF &lt; 45%) underwent fasting FDG PET/CT. Resting metabolic scans were followed by adenosine infusion and repeat imaging. The primary endpoint was the number of myocardial segments demonstrating increased FDG uptake during adenosine infusion, and secondary endpoints included image quality, hemodynamic changes, and adverse events. Images were analyzed using a 17-segment model. Hemodynamic responses and adverse events were recorded. Continuous variables were summarized as mean ± SD and compared using paired t-tests or Wilcoxon signed-rank tests, as appropriate. Categorical variables were reported as counts and percentages and analyzed with the McNemar test. A p-value &lt; 0.05 was considered statistically significant.</p> Results <p>Adenosine significantly increased mismatch segments (4.1 ± 1.4 vs. 2.3 ± 1.1 at rest; <i>p</i> &lt; 0.001) and improved image quality (4.1 ± 0.4 vs. 3.2 ± 0.6; <i>p</i> = 0.02). The global relative FDG uptake score improved (8.7 ± 2.9 to 12.4 ± 3.2; <i>p</i> &lt; 0.01). Adenosine imaging revealed metabolically active segments that appeared nonviable at rest in 71% of patients. Heart rate increased modestly (69 ± 8 to 87 ± 12&#xa0;bpm; <i>p</i> &lt; 0.001), while systolic blood pressure remained stable. Adenosine was well tolerated, with no serious adverse events.</p> Conclusions <p>Adenosine FDG PET/CT enhances FDG uptake in previously hypometabolic myocardial segments, suggesting the presence of potentially viable tissue that may be missed on resting imaging. This approach may improve decision making regarding revascularization in ischemic cardiomyopathy.</p>

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Adenosine FDG PET/CT reveals potentially viable myocardium in ischemic cardiomyopathy

  • 期刊论文

  • 发表日期：

    2026年3月27日

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  • Mutlay Keskin

摘要

Objective

Accurate assessment of myocardial viability is essential in ischemic cardiomyopathy, yet resting FDG PET/CT may underestimate viable tissue in segments with impaired perfusion or ischemia induced insulin resistance. This study evaluated whether adenosine stimulated FDG PET/CT enhances the detection of viable myocardium in patients with ischemic cardiomyopathy for revascularization, compared with resting FDG PET/CT.

Methods

Twenty-one nondiabetic patients with ischemic cardiomyopathy (LVEF < 45%) underwent fasting FDG PET/CT. Resting metabolic scans were followed by adenosine infusion and repeat imaging. The primary endpoint was the number of myocardial segments demonstrating increased FDG uptake during adenosine infusion, and secondary endpoints included image quality, hemodynamic changes, and adverse events. Images were analyzed using a 17-segment model. Hemodynamic responses and adverse events were recorded. Continuous variables were summarized as mean ± SD and compared using paired t-tests or Wilcoxon signed-rank tests, as appropriate. Categorical variables were reported as counts and percentages and analyzed with the McNemar test. A p-value < 0.05 was considered statistically significant.

Results

Adenosine significantly increased mismatch segments (4.1 ± 1.4 vs. 2.3 ± 1.1 at rest; p < 0.001) and improved image quality (4.1 ± 0.4 vs. 3.2 ± 0.6; p = 0.02). The global relative FDG uptake score improved (8.7 ± 2.9 to 12.4 ± 3.2; p < 0.01). Adenosine imaging revealed metabolically active segments that appeared nonviable at rest in 71% of patients. Heart rate increased modestly (69 ± 8 to 87 ± 12 bpm; p < 0.001), while systolic blood pressure remained stable. Adenosine was well tolerated, with no serious adverse events.

Conclusions

Adenosine FDG PET/CT enhances FDG uptake in previously hypometabolic myocardial segments, suggesting the presence of potentially viable tissue that may be missed on resting imaging. This approach may improve decision making regarding revascularization in ischemic cardiomyopathy.