|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2002; 40:1735-1743 © 2002 by the American College of Cardiology Foundation |
* Cardiac PET Centre, Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Divisions of Cardiology and Cardiac Surgery, Toronto Hospital Western and General Divisions and St. Michael’s Hospital, University of Toronto Health Sciences Network, Toronto, Ontario, Canada
E. S. Garnett Memorial PET Centre, Department of Radiology, McMaster University and Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
Divisions of Cardiology and Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
|| Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
¶ Cardiovascular Outcomes Related to Economics Group, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
Manuscript received February 15, 2002; revised manuscript received May 24, 2002, accepted June 24, 2002.
* Reprint requests and correspondence: Dr. Rob S. B. Beanlands, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
rbeanlands{at}ottawaheart.ca
OBJECTIVES: The aim of this study was to determine whether the extent of viability or scar is important in the amount of recovery of left ventricular (LV) function, and to develop a model for predicting recovery after revascularization that could be tested in a randomized trial.
BACKGROUND: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is used to define viable myocardium in patients with coronary artery disease (CAD) and severe LV dysfunction and to guide revascularization decisions. Whether this approach improves clinical outcomes has not been tested in a randomized trial. Before doing so, an objective model for prediction of recovery is required.
METHODS: A total of 82 patients with CAD and an ejection fraction (EF) 
35% had FDG PET perfusion imaging before revascularization. Complete follow-up was available on 70 patients (86%). Patients had radionuclide angiograms at baseline and three months post-revascularization.
RESULTS: Diabetes (p = 0.029), time to operation (p = 0.008), and scar score (p = 0.001) were significant independent predictors of the change in EF. Previous coronary artery bypass graft confounded the effect of age. There was a significant interaction between the perfusion tracer used and mismatch score (p = 0.02). The multivariable prediction model incorporating PET and clinical variables had a goodness of fit with p = 0.001. Across tertiles of scar scores (I, small: 0% to 16%; II, moderate: 16% to 27.5%; III, large: 27.5% to 47%), the changes in EFs were 9.0 ± 1.9%, 3.7 ± 1.6%, and 1.3 ± 1.5% (p = 0.003: I vs. III), respectively.
CONCLUSIONS: In patients with severe LV dysfunction, the amount of scar was a significant independent predictor of LV function recovery after revascularization. A combination of PET and clinical parameters predicts the degree of recovery. This model is being applied in a large randomized controlled trial to determine the effectiveness of therapy guided by FDG PET.
| ||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  X. Zhang, X.-j. Liu, S. Hu, T. H. Schindler, Y. Tian, Z.-x. He, R. Gao, Q. Wu, H. Wei, J. W. Sayre, et al. Long-Term Survival of Patients with Viable and Nonviable Aneurysms Assessed by 99mTc-MIBI SPECT and 18F-FDG PET: A Comparative Study of Medical and Surgical Treatment J. Nucl. Med., August 1, 2008; 49(8): 1288 - 1298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Camici, S. K. Prasad, and O. E. Rimoldi Stunning, Hibernation, and Assessment of Myocardial Viability Circulation, January 1, 2008; 117(1): 103 - 114. [Full Text] [PDF]
|
|
|
|
 |
|
 R. S.B. Beanlands, G. Nichol, E. Huszti, D. Humen, N. Racine, M. Freeman, K. Y. Gulenchyn, L. Garrard, R. deKemp, A. Guo, et al. F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction and Suspected Coronary Disease: A Randomized, Controlled Trial (PARR-2) J. Am. Coll. Cardiol., November 13, 2007; 50(20): 2002 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F.L. Schinkel, D. Poldermans, A. Elhendy, and J. J. Bax Assessment of Myocardial Viability in Patients with Heart Failure J. Nucl. Med., July 1, 2007; 48(7): 1135 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Penicka, P. Tousek, B. De Bruyne, W. Wijns, O. Lang, J. Madaric, M. Vanderheyden, J. Tintera, M. Maly, P. Widimsky, et al. Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization Eur. Heart J., June 1, 2007; 28(11): 1366 - 1373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Di Carli and R. Hachamovitch New Technology for Noninvasive Evaluation of Coronary Artery Disease Circulation, March 20, 2007; 115(11): 1464 - 1480. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pocar, A. Moneta, A. Grossi, and F. Donatelli Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow-Up Ann. Thorac. Surg., February 1, 2007; 83(2): 468 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Thompson, G. Saab, D. Birnie, B. J.W. Chow, H. Ukkonen, K. Ananthasubramaniam, R. A. deKemp, L. Garrard, T. D. Ruddy, J. N. DaSilva, et al. Is Septal Glucose Metabolism Altered in Patients with Left Bundle Branch Block and Ischemic Cardiomyopathy? J. Nucl. Med., November 1, 2006; 47(11): 1763 - 1768. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Desideri, L. Cortigiani, A. I. Christen, S. Coscarelli, D. Gregori, P. Zanco, R. Komorovsky, and J. J. Bax The Extent of Perfusion-F18-Fluorodeoxyglucose Positron Emission Tomography Mismatch Determines Mortality in Medically Treated Patients With Chronic Ischemic Left Ventricular Dysfunction J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1264 - 1269. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V Rizzello, D Poldermans, E Biagini, A F L Schinkel, R van Domburg, A Elhendy, E C Vourvouri, M Bountioukos, A Lombardo, B Krenning, et al. Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium Heart, March 1, 2005; 91(3): 319 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Doenst, E. J. Velazquez, F. Beyersdorf, R. Michler, L. Menicanti, M. Di Donato, S. Gradinac, B. Sun, V. Rao, and For the STICH Investigators To STICH or not to STICH: We know the answer, but do we understand the question? J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 246 - 249. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A Gorog, M. Tanno, X. Cao, M. Bellahcene, R. Bassi, A. M.N Kabir, K. Dighe, R. A Quinlan, and M. S Marber Inhibition of p38 MAPK activity fails to attenuate contractile dysfunction in a mouse model of low-flow ischemia Cardiovasc Res, January 1, 2004; 61(1): 123 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. Knuesel, D. Nanz, C. Wyss, M. Buechi, P. A. Kaufmann, G. K. von Schulthess, T. F. Luscher, and J. Schwitter Characterization of Dysfunctional Myocardium by Positron Emission Tomography and Magnetic Resonance: Relation to Functional Outcome After Revascularization Circulation, September 2, 2003; 108(9): 1095 - 1100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Di Carli, R. Hachamovitch, and D. S. Berman The art and science of predicting postrevascularization improvement in left ventricular (LV) function in patients with severely depressed LV function J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1744 - 1747. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
