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Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and

Mehdi Namdar1, Olivier Rager2, Julien Priamo3

  • 1Division of Cardiology, University Hospital Geneva, Geneva, Switzerland.

The International Journal of Cardiovascular Imaging
|May 30, 2018
PubMed

Insights

Cardiac FDG-PET/CT identifies viable myocardium in elderly patients with coronary artery disease. Revascularization in these patients improves outcomes and survival, suggesting a benefit for this intervention.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Geriatrics

Background:

  • Cardiac viability imaging in elderly patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (rLVEF) is understudied.
  • FDG-PET/CT is a key imaging modality for assessing myocardial viability.

Purpose of the Study:

  • To evaluate the prognostic value of FDG-PET/CT in elderly patients ( > 65 years) with CAD and rLVEF before revascularization.
  • To determine if viable myocardium identified by FDG-PET/CT predicts outcomes in this population.

Main Methods:

  • Retrospective analysis of 89 elderly patients with CAD and rLVEF undergoing cardiac FDG-PET/CT.
  • Patients were stratified based on the presence of viable myocardium and subsequent revascularization.
  • Clinical endpoints included all-cause mortality and acute cardiac event hospitalizations.

Main Results:

  • Viable myocardium was present in 64 patients.
  • Revascularization was associated with improved left ventricular ejection fraction (LVEF) (3.8 ± 6.6%, P=0.013) compared to no revascularization (-0.75 ± 2.6%, P=0.170).
  • Viable myocardium, if not revascularized, was significantly associated with fatal events (Log-rank P=0.037; multivariate analysis P=0.012).

Conclusions:

  • Elderly patients with viable myocardium demonstrated improved LVEF and survival after revascularization compared to those denied the procedure.
  • Cardiac FDG-PET/CT identified viable myocardium, which was associated with better clinical outcomes in elderly patients when revascularized.
  • FDG-PET/CT can guide revascularization decisions in elderly patients with CAD and rLVEF.

Keywords:
CardiacElderlyPET/CTViability imaging

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