ORIGINAL PAPER Prediction of long-term reverse left ventricular remodeling after revascularization or medical treatment in patients with ischemic cardiomyopathy: a comparative study between SPECT and MRI Tomas Skala • Martin Hutyra • Jan Vaclavik • Milan Kaminek • David Horak • Josef Novotny • Jana Zapletalova • Jan Lukl • Dan Marek • Milos Taborsky Received: 19 March 2010 / Accepted: 24 July 2010 Ó Springer Science+Business Media, B.V. 2010 Abstract Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were pro- spectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow- up ( [ 5%—responders). MRI with B5 segments with DE/wall thickness ratio (DEWTR) C50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of B2 segments with the DEWTR C75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT \ 16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preop- erative number of segments with the DE/wall thickness ratio of C50 and C75% obtained by MRI, was found to be a better predictor of left ventricular reverse remod- eling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improve- ment at 24 months after CABG. Keywords Ischemic heart disease Á Cardiac magnetic resonance Á Late Gadolinium enhancement Á Perfusion defect Á Ejection fraction Introduction Revascularization in patients with coronary artery disease and left ventricular (LV) dysfunction has been shown to improve LV function, heart failure symptoms and prognosis [1–6]. Unfortunately, these patients tend to develop varying degrees of LV reverse remodeling and improvement of ejection fraction (EF) after T. Skala (&) Á M. Hutyra Á J. Vaclavik Á J. Lukl Á D. Marek Á M. Taborsky 1st Department of Internal Medicine (Cardiology), University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic e-mail: tomasskala@gmail.com M. Kaminek Department of Nuclear Medicine, University Hospital Olomouc, Olomouc, Czech Republic D. Horak Department of Radiodiagnostics, University Hospital Olomouc, Olomouc, Czech Republic J. Novotny Department of Radiodiagnostics, Military Hospital Olomouc, Olomouc, Czech Republic J. Zapletalova Department of Biophysics, Palacky University Olomouc, Olomouc, Czech Republic 123 Int J Cardiovasc Imaging DOI 10.1007/s10554-010-9677-1