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Updated: Aug 15, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
The extent of perfusion-F18-fluorodeoxyglucose positron emission tomography mismatch determines mortality in
Alessandro Desideri1, Lauro Cortigiani, Alejandra Ines Christen
1Cardiovascular Research Foundation, S. Giacomo Hospital, Castelfranco Veneto, Italy. aldesi@tin.it
Insights
Patients with ischemic cardiomyopathy and significant viable heart tissue face high cardiac death risk when treated medically. Positron emission tomography (PET) helps identify this risk, guiding prognosis.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Ischemic cardiomyopathy prognosis is influenced by myocardial viability.
- The role of viability extent in medically treated patients remains unclear.
Purpose of the Study:
- To assess mortality determinants in medically treated ischemic cardiomyopathy patients.
- To evaluate the impact of viable tissue extent on prognosis.
Main Methods:
- 261 patients with ischemic cardiomyopathy underwent positron emission tomography (PET) for viability assessment.
- Prospective follow-up was conducted to determine outcomes.
Main Results:
- Revascularized patients had lower cardiac death rates (13%) than medically treated patients (24%).
- In medically treated patients, age, left bundle branch block, and extent of perfusion-metabolism mismatch on PET predicted cardiac death.
- A mismatch extent >20% significantly increased cardiac death risk (HR 3.21).
Conclusions:
- Medically treated ischemic cardiomyopathy patients with extensive viable myocardium are at high risk for cardiac death.
- PET assessment of myocardial viability is crucial for risk stratification.
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 < or =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.
