One case of"reverse mismatch"in nuclear imaging of end-stage heart failure patient
LI Xiaoya
LIU Jianying
SUN Ben
ZHAO Xiuyi
SHAO Yahui
Abstract：The patient was admitted to hospital due to"recurrent chest tightness and shortness of breath".Physical ex-amination indicated bilateral pulmonary rales and heart murmurs,as well as bilateral lower extremities edema.According to the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,through radioactive nuclide imaging,echocardiography,coronary angiography,and laboratory results,the patient's diagnosis of coronary heart disease and end-stage heart failure was confirmed.Despite percutaneous coronary intervention(PCI)and drugs,the patient's con-dition did not improve and she died two months later.The radionuclide myocardial perfusion images of this patient showed mild to moderate perfusion reduction areas,but there was severe or nearly defect-like 18F-FDG metabolism,which was dif-ferent from the common"image mismatch"of ischemic but viable myocardium and the"image match"of infarcted myocardi-um in terms of perfusion and metabolism,presenting a"reverse mismatch".This suggests that this part of the myocardium is in a severe near-death state,that existing treatments do not respond well,or that it takes a long time for the myocardium to recover function.This case suggests that the degree of FDG metabolism reduction in viable myocardium can reflect the severity of myocardial injury and may also be an important factor affecting prognosis.
Keywords：myocardial perfusion imagingmyocardial metabolism imagingheart failurepercutaneous coronary interventional
Publication Date：2025-02-24
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 56-59 )