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CLINICAL RESEARCH: CHRONIC CORONARY DISEASE

The Extent of Perfusion–F18-Fluorodeoxyglucose Positron Emission Tomography Mismatch Determines Mortality in Medically Treated Patients With Chronic Ischemic Left Ventricular Dysfunction

Alessandro Desideri, MD, FACC^_*,_*, Lauro Cortigiani, MD^_*, Alejandra Ines Christen, MD^_*, Sebastian Coscarelli, MD^_*, Dario Gregori, PhD, Pierluigi Zanco, MD, Roman Komorovsky, MD^_* and Jeroen J. Bax, MD

^_* Cardiovascular Research Foundation, "S. Giacomo" Hospital, Castelfranco Veneto, Italy
Department of Public Health and Microbiology, University of Torino, Torino, Italy
PET Center, Nuclear Medicine Department, "S. Giacomo" Hospital, Castelfranco Veneto, Italy
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received February 28, 2005; revised manuscript received June 7, 2005, accepted June 13, 2005.

^_* Reprint requests and correspondence: Dr. Alessandro Desideri, Cardiovascular Research Foundation, S. Giacomo Hospital, 31033 Castelfranco Veneto (TV), Italy. (Email: aldesi{at}tin.it).

OBJECTIVES: The purpose of this study was to assess the determinants of mortality in a large group of patients with ischemic cardiomyopathy who are treated medically and the impact of the extent of viable tissue on prognosis.

BACKGROUND: Whether the presence of viability drives mortality in patients with ischemic cardiomyopathy who are treated medically and whether the extent of viability is important are issues that are currently unclear.

METHODS: Two hundred sixty-one patients with ischemic cardiomyopathy underwent positron emission tomography (PET) for assessment of viability. Prospective follow-up was obtained.

RESULTS: Ninety-four patients were revascularized and 167 were not. The cardiac death rate was significantly less in the revascularized patients as compared with medically treated patients (13% vs. 24%, p < 0.05). In the revascularized patients, there was a trend toward better survival in patients with viable myocardium as compared with nonviable myocardium (3.5-year survival, 85% and 75% respectively, p = NS). In the medically treated group, age (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.2 to 3.7), presence of left bundle branch block (HR 3.4, 95% CI 1.6 to 7.2) and extent of perfusion-metabolism mismatch on PET (HR 1.36, 95% CI 1.1 to 1.6) predicted cardiac death during a median follow-up period of 2.1 years. The risk of cardiac death was not significantly increased when the extent of mismatch was 20% (HR 0.97, 95% CI 0.46 to 2.05) but was significantly increased when the extent of mismatch was >20% (HR 3.21, 95% CI 1.38 to 7.49).

CONCLUSIONS: Medically treated patients with ischemic cardiomyopathy and large areas of viable myocardium on PET are at high risk for cardiac death.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CAD = coronary artery disease   EF = ejection fraction   FDG = F18-fluorodeoxyglucose   LBBB = left bundle branch block   LV = left ventricle/ventricular   MI = myocardial infarction   PET = positron emission tomography

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