Correlation of reverse mismatched defect patternsin cardiac perfusion and metabolism imaging with clinical parameters

SUMMARY The aim of our study was to obtain information about the pathophysiologic mechanisms and clinical significance of this pattern in patients with reverse mismatch patterns. Technetium 99 metastable methoxy isobutyl isonitrile miyocard perfusion single photon emission computed tomography and fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography images of patients who underwent both imaging in our center were retrospectively retrieved from the archive and evaluated with polar maps by 2 different nuclear medicine physicians and 28 patients with diffuse reverse mismatch pattern were included in the study. Basal sections were excluded to avoid false positives. A 42-patient control group was randomly selected from the group of patients with no reverse mismatched pattern. Follow-up data and pre-imaging preparation data of these patients were accessed through the archive. Statistical analyses revealed a moderate positive correlation between the percentage of mismatched pattern and the patient's fasting blood glucose measured at presentation (r= 0.424, p=0.028). The frequency of hyperlipidemia diagnosis was significantly higher in the patient group with reverse mismatch pattern (p=0.035). Resting perfusion defect percentage was lower in the group with reverse mismatch pattern compared to the control group (p=0.038). When the areas of ischemia in patients with mismatched pattern were compared with the areas with reverse mismatched pattern, 67% of the patients had different areas. In 61% of patients with reverse mismatch pattern, wall motion abnormality was detected in these areas. 82.1% of patients with an reverse mismatch pattern had hiberneous tissue. There was no statistically significant difference between patients with reverse mismatch pattern and the control group in terms of diabetes, bundle branch block, history of recent cardiac events, presence of hyberneous tissue, presence of scar tissue, frequency of major cardiac events and event-free survival time (p=0.921, p=0.304, p=0.586, p=0.900, p=0.394, p=0.827, p=0.341). We suggest that patient management that takes into account the complex adaptive changes in cardiac glucose metabolism and the reverse mismatch pattern in fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography imaging of cardiac glucose metabolism will lead to better outcomes. Key words: Cardiac F-18 FDG PET/CT, reverse mismatch pattern, reverse mismatch, flip flop