The potential for PET-guided revascularization of coronary artery disease (original) (raw)
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Journal of Nuclear Medicine, 2011
Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PETdriven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 6 11 y (96 men, 23 women); global left ventricle MPR was 1.54 6 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P 5 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.32145.5) (P 5 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P 5 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
Journal of the American College of Cardiology, 2001
We sought to prospectively compare nitrogen-13 ( 13 N)-ammonia/ 18 fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET)-guided management with stress/rest technetium-99m ( 99m Tc)-sestamibi single-photon emission computed tomography (SPECT)-guided management. BACKGROUND Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis.
2006
Background. Traditionally, cardiac fluorodeoxyglucose (FDG) uptake is combined with regional perfusion for optimal evaluation of viability. Gated FDG-positron emission tomography (PET) may be an alternative technique for detection of viability because it permits combined assessment of glucose metabolism uptake and wall thickening (WT). In this study the value of FDG uptake and WT (analyzed from a stand-alone gated FDG-PET study) for the prediction of recovery of regional and global left ventricular (LV) function in patients with coronary artery disease undergoing revascularization is studied.
The International Journal of Cardiovascular Imaging, 2010
In patients with ischemic cardiomyopathy, coronary artery bypass grafting (CABG) offers an important therapeutic option but is still associated with high perioperative mortality. Although previous studies suggest a benefit from revascularization for patients with defined viability by a non-invasive technique, the role of viability assessment to determine suitability for revascularization in patients with ischemic cardiomyopathy has not yet been defined. This study evaluates the hypothesis that the use of PET imaging in the decision-making process for CABG will improve postoperative patient survival. We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction B0.35) who were considered candidates for CABG between 1994 and 2004 on the basis of clinical presentation and angiographic data. In a Standard Care Group, 298 patients underwent CABG. In a second PET-assisted management group of 178 patients, 152 patients underwent CABG (PET-CABG) and 26 patients were excluded from CABG because of lack of viability (PET-Alternatives). Primary endpoint was postoperative survival. There were two in hospital deaths in the PET-CABG (1.3%) and 30 (10.1%) in the Standard Care Group (P = 0.018). The survival rate after 1, 5 and 9.3 years was 92.0, 73.3 and 54.2% in the PET-CABG and 88.9, 62.2 and 35.5% in the Standard Care Group, respectively (P = 0.005). Coxregression analysis revealed a significant influence on long-term survival of patient selection by viability assessment via PET (P = 0.008), of LV-function (P = 0.017), and age [70 (P = 0.016). Preoperative assessment of myocardial viability via PET identifies patients, who will benefit most from CABG.