Abstract
Purpose: Coronary capillary filling can be visualized during selective coronary angiography if the cine camera is allowed to run until venous circulation is observed. We hypothesized that visualization of capillary filling during coronary angiography in regions of dysfunctional myocardium might indicate myocardial viability. Methods: Twenty-six patients (pts) (mean age 62.3, 23 males, 3 females) who underwent positron emission tomography (PET) and coronary angiography were studied. All pts had previous myocardial infarction and significant left ventricular dysfunction with severe hypokenesis or akinesis of the infarct segments. Only pts with preserved antegrade flow or excellent collateral flow (grade II or III) to the dyssynergic myocardial segments were included. PET scans were performed using N13 ammonia and F18 deoxyglucose. Matching defects were defined as scar and mismatches were designated as viable. Results: Thirty-seven myocardial segments showed PET abnormalities. There were 23 scar and 14 viable segments. Of the 23 segments indicating scar, 69% (16/23) showed capillary flow in the infarct area. Capillary flow was noted 85% (12/14) of viable segments. The positive predictive value of capillary flow is only 42%. Conclusions: Demonstration of capillary flow in the infarct segments, during coronary angiography, does not predict myocardial viability.