The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic

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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
08:13

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

Published on: February 16, 2016

Christopher Uebleis1, Stefan Hellweger, Rüdiger Paul Laubender

  • 1Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.

The International Journal of Cardiovascular Imaging
|June 8, 2013
PubMed

Insights

Combined myocardial perfusion SPECT and [18F]FDG PET viability scanning helps predict survival in ischemic cardiomyopathy. A 5% mismatch threshold indicates which patients benefit most from early revascularization for improved long-term outcomes.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Medical Imaging

Background:

  • Ischemic cardiomyopathy (iCMP) with left ventricular dysfunction poses significant prognostic challenges.
  • Accurate prediction of survival is crucial for guiding therapeutic decisions in these patients.

Purpose of the Study:

  • To assess the prognostic value of combined single-photon emission computed tomography (SPECT) and positron emission tomography (PET) viability scanning.
  • To determine if myocardial perfusion SPECT and [18F]FDG PET mismatch predicts survival in patients with iCMP and left ventricular dysfunction.

Main Methods:

  • 244 patients with iCMP and LVEF ≤ 45% underwent combined SPECT/PET imaging.
  • Myocardial scar and SPECT/PET-mismatch (%-mismatch) were quantified.
  • Event-free survival was correlated with therapy (medical, with/out revascularization) and %-mismatch.

Main Results:

  • A threshold of ≥ 5% SPECT/PET-mismatch was identified as a key predictor.
  • Patients with ≥ 5% mismatch who did not receive early revascularization (ER) had significantly higher mortality.
  • SPECT/PET-mismatch and its interaction with ER were independent predictors of all-cause mortality.

Conclusions:

  • Combined SPECT/PET viability scanning provides significant prognostic information in iCMP patients.
  • A ≥ 5% SPECT/PET-mismatch threshold effectively identifies patients who benefit from early revascularization for improved long-term survival.

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