Incremental prognostic value of left ventricular function by myocardial ECG-gated FDG PET imaging in patients with ischemic cardiomyopathy
Section snippets
Patient population
The population studied was selected from a cohort of 137 consecutively tested patients between January 1995 and April 1999 undergoing rest myocardial perfusion and ECG-gated FDG metabolism PET studies in the assessment of myocardial viability for potential myocardial revascularization. Of the original 137 patients, 47 were excluded: 27 because of imaging issues (technical problems in 16 and no images available in 11) and 20 with LVEF greater than 40%. Finally, 90 patients with documented CAD
Baseline characteristics of patients
Patients enrolled in this study had advanced coronary heart disease. All patients had significant coronary artery stenosis and previous myocardial infarction (Table 1). In addition, more than 25% of the population had cardiac surgery, hypertension, or heart failure. The mean LVEF by gated FDG PET was 26% ± 7%. A total of 38 patients exhibited a perfusion-metabolic mismatch pattern, whereas 52 patients had a match pattern between perfusion and metabolism.
Clinical outcomes
During the follow-up period (mean, 22 ±
Discussion
This study revealed that, in a population with severely reduced LVEF due to CAD referred for myocardial viability testing, measures of LV remodeling (ie, LV volumes and mass) have incremental prognostic value over the perfusion-metabolism PET mismatch pattern in predicting cardiac events. In a risk-adjusted Cox model, the 2-year event-free survival rate was consistently higher for patients with relatively preserved LVEF as well as heart size and mass compared with those with severely reduced
Acknowledgment
Some of the authors (E.V.G. and T.L.F.) receive royalties from the sale of the Emory Cardiac Toolbox related to the research described in this article. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest practice. The other authors have indicated they have no financial conflicts of interest.
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Funded in part by the National Institutes of Health; National Heart, Lung, and Blood Institute grant Nos. K01 HL70422 and R01 HL68904; and the 2001 American Society of Nuclear Cardiology/Fujisawa Award for Basic or Applied Scientific Research in Nuclear Cardiology.