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Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor
K L Gould1, D Ornish, L Scherwitz
1Department of Medicine, University of Texas Medical School at Houston 77030, USA.
JAMA
|September 20, 1995
Summary
Comprehensive risk factor modification, including diet and exercise, significantly improved myocardial perfusion abnormalities in patients with coronary artery disease over five years. Positron emission tomography (PET) demonstrated these improvements, indicating disease regression.
Area of Science:
- Cardiology
- Nuclear Medicine
- Preventive Cardiology
Background:
- Coronary artery disease (CAD) management traditionally focuses on antianginal therapy.
- Lifestyle interventions are increasingly recognized for their potential to modify CAD progression.
- Objective quantification of myocardial perfusion changes is crucial for assessing treatment efficacy.
Purpose of the Study:
- To quantitatively assess changes in myocardial perfusion abnormalities using positron emission tomography (PET) after five years of intensive risk factor modification in CAD patients.
- To compare the effects of a comprehensive lifestyle intervention program versus usual care on coronary artery disease severity.
Main Methods:
- A randomized controlled trial involving 35 patients with CAD, divided into an experimental group (n=20) receiving risk factor modification and a control group (n=15) receiving usual care.
- Risk factor modification included a very low-fat vegetarian diet, moderate exercise, stress management, and group support.
- Quantitative coronary arteriography and rest-dipyridamole PET scans were performed at baseline and after five years, with automated analysis of perfusion and stenosis severity.
Main Results:
- The experimental group showed significant improvement (decrease) in the size and severity of myocardial perfusion abnormalities on PET scans compared to the control group, which exhibited worsening.
- Specific metrics, including the percentage of left ventricle with abnormalities and reduced activity, improved significantly in the intervention group (P=.02, P=.002).
- Changes in PET-derived perfusion abnormalities were comparable to or greater than changes observed in coronary stenosis severity via quantitative coronary arteriography.
Conclusions:
- Intensive risk factor modification is associated with regression of coronary artery stenoses and significant improvement in myocardial perfusion abnormalities.
- Dipyridamole PET imaging provides a non-invasive method to monitor the progression or regression of coronary artery disease by assessing integrated coronary flow capacity.
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