J. Wells Askew et al. JIMG 2009;2:

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J. Wells Askew et al. JIMG 2009;2:661-663 PET Myocardial Perfusion and Metabolic Images in Presence of LBBB An 86-year-old male with ischemic cardiomyopathy (New York Heart Association functional class III symptoms), left ventricular ejection fraction of 25%, prior coronary artery bypass grafting surgery, and left bundle branch block underwent a resting myocardial perfusion study using N-13 ammonia (759.6 MBq, 20.53 mCi) and metabolic assessment using a standard hyperinsulinemic-euglycemic clamp protocol and F-18 fluorodeoxyglucose (622.3 MBq, 16.82 mCi). Representative short-axis slice, long-axis (horizontal and vertical) slices, and polar maps (right) demonstrate septal reverse mismatch with preserved perfusion in the septal wall compared with a marked reduction (predominantly) in the septal portion of the F-18 fluorodeoxyglucose metabolic images in the setting of a left bundle branch block. Semiquantitative analysis by quantitative perfusion single-photon emission computed tomography (using the lateral wall as the reference), confirmed the visual reverse mismatch between the perfusion and metabolism images with septal-to-lateral ratios of 1.1 for N-13 ammonia and 0.15 for F-18 fluorodeoxyglucose. Abbreviations as in Figure 1. J. Wells Askew et al. JIMG 2009;2:661-663 American College of Cardiology Foundation