Limited prognostic value of myocardial viability assessment in patients with coronary artery diseases and severe left
Yihua Liu1, Yefan Jiang1, Xiaoxi Yang2
1Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Insights
Positron Emission Tomography (PET) for myocardial viability assessment has limited prognostic value in patients with coronary artery disease and severe left ventricular dysfunction. Functional recovery after revascularization does not always improve survival outcomes.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Myocardial viability assessment is crucial for patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction to guide revascularization decisions.
- The prognostic significance of myocardial viability testing in this patient population remains a subject of debate.
- 18F-fluorodeoxyglucose Positron Emission Tomography (18FDG-PET) is a key imaging modality for assessing myocardial viability.
Purpose of the Study:
- To evaluate the prognostic value of 18FDG-PET for myocardial viability assessment in patients with CAD and severe LV dysfunction.
- To determine if myocardial viability identified by 18FDG-PET predicts outcomes after coronary artery bypass grafting (CABG).
- To compare survival and major adverse cardiovascular and cerebrovascular events (MACCE) among patients with different extents of myocardial scar.
Main Methods:
- 18FDG-PET was performed in 81 patients with ischemic LV dysfunction (ejection fraction ≤35%) before CABG.
- Patients were categorized based on myocardial scar burden (≥10% vs. <10%) after CABG, or received optimal medical treatment (OMT) if contraindicated for surgery.
- Outcomes, including all-cause mortality and MACCE, were assessed over a median follow-up of 32 months.
Main Results:
- 18FDG-PET showed significant differences in myocardial viability and scar extent among the groups (P<0.01).
- Echocardiographic parameters like LV diastolic dimension and ejection fraction also differed significantly (P<0.05).
- Despite differences in viability, Kaplan-Meier analysis revealed no significant differences in overall survival (P=0.74) or MACCE-free survival (P=0.66) among the three groups.
Conclusions:
- 18FDG-PET assessment of myocardial viability has limited prognostic value in patients with CAD and severe LV dysfunction.
- A substantial myocardial scar burden, even with viable myocardium, does not guarantee survival benefits after surgical revascularization.
- The findings suggest that viability testing alone may not be sufficient to predict outcomes in this complex patient group.
Background:
Myocardial viability assessment is typically performed in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction to identify those who might benefit from revascularization and assist in decision making process. However, the prognostic value of myocardial viability testing remains a debating issue.
Methods:
Positron Emission Tomography using 18F-fluorodeoxyglucose (18FDG-PET) was performed in 81 patients with ischemic LV dysfunction [ejection fraction (EF) ≤35%] for myocardial viability assessment prior to coronary artery bypass surgery. Fifty-three of them received finally coronary artery bypass grafting and were divided into two groups according to the extent of myocardial scar: one group with scar burden ≥10% (n=30) and the other with scar burden <10% (n=23). The remaining patients were contraindicated for CABG and received optimal medical treatment (OMT, n=28). All patients were followed up and the primary endpoint was all-cause mortality and the secondary endpoint was a composite of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE).
Results:
18FDG-PET revealed a different profile of myocardial viability among three groups with respect to the extent of myocardial scar, the hibernating myocardium (both P<0.01), some echocardiographic parameters such as left ventricular diastolic dimension (LVDD) and EF were also significantly different (both P<0.05). Nevertheless, the baseline prevalence of comorbidities and functional classifications were comparable. The per-procedural parameters were not significantly different between two CABG groups. In a median follow-up time of 32 months, Kaplan Meier analysis uncovered no significant difference in terms of overall survival (P=0.74) and MACCE-free survival (P=0.66) among three groups.
Conclusions:
Myocardial viability assessment using 18FDG-PET is of limited prognostic value in patients with CAD and severe LV dysfunction. In patients with substantial myocardial scar burden despite the existence of considerable hibernating myocardium, functional recovery following surgical revascularization is not necessarily translated to survival benefits.
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