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Identification and revascularization of hibernating myocardium in angina-free patients with left ventricular
G Paolini1, G Lucignani, M Zuccari
1Institute of Cardiovascular and Respiratory Diseases, University of Milan, Italy.
Insights
Viable myocardium detection using [18F]FDG-PET predicts successful coronary revascularization in patients with left ventricular dysfunction and severe coronary artery disease, improving outcomes after surgery.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiac Surgery
Background:
- Left ventricular dysfunction and severe multi-vessel coronary artery disease often present without clear ischemic symptoms.
- Accurate assessment of myocardial viability is crucial for surgical decision-making in these patients.
Purpose of the Study:
- To evaluate the predictive value of combined cardiac perfusion and metabolism imaging for successful coronary revascularization.
- To determine if the presence of viable myocardium predicts improved outcomes in patients with left ventricular dysfunction and coronary artery disease.
Main Methods:
- Seventeen angina-free patients with left ventricular dysfunction underwent [99mTc]MIBI/SPET for perfusion and [18F]FDG/PET for metabolism assessment.
- Coronary surgery was considered if viable myocardium was detected in at least two segments with wall motion abnormalities and perfusion defects.
- Patients were followed for a mean of 28.4 months.
Main Results:
- Nine patients underwent coronary artery bypass grafting, all survived hospitalization, and showed improved NYHA functional class post-surgery.
- Six patients received medical treatment, and three of them experienced worsened clinical status.
- Two patients awaiting heart transplantation died.
Conclusions:
- Positron emission tomography ([18F]FDG-PET) can effectively identify viable myocardium in patients with left ventricular dysfunction and severe coronary artery disease.
- The presence of viable myocardium is a strong predictor of successful coronary revascularization and improved clinical outcomes.
Abstract:
We examined 17 angina-free patients with left ventricular dysfunction, referred for surgical decision-making, who presented with no or few signs and symptoms of myocardial ischemia according to treadmill stress test. On cardiac catheterization they were affected by severe multi-vessel coronary artery disease; the mean left end-diastolic pressure of this population was 26.3 +/- 5.5 mm Hg (mean +/- SD) and their mean ejection fraction was 27.6 +/- 4.9% (mean +/- SD). They all were investigated for the presence of viable myocardium by the combined assessment of cardiac perfusion and metabolism using single photon emission tomography with [99mTc] labelled hexakis-2-methoxy-isobutyl-isonitrile [99mTc]MIBI/SPET) and positron emission tomography with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG/PET), respectively. Patients were considered for coronary surgery when [18F]FDG was detectable in at least two cardiac segments with wall motion abnormalities and perfusion defects. Nine patients were operated on, six were medically treated and two were scheduled for heart transplantation. We recorded no in-hospital mortality. At a mean follow-up of 28.4 +/- 9.8 (mean +/- SD) months all surgical patients were alive and their NYHA functional classes have improved, except in one case. Among the patients refused for bypass surgery, three are in stable conditions, three have worsened clinical statuses and two died while waiting for heart transplantation. In conclusion, for patients with bypassable coronaries, left ventricular dysfunction and lack of angina, successful coronary revascularization may be predicted by the presence of viable myocardium demonstrated with positron emission tomography.