[Myocardial revascularization in patients with impaired left ventricular function]

Area of Science:

• Cardiology
• Nuclear Medicine
• Cardiac Surgery

Background:

• Coronary artery disease (CAD) and left ventricular dysfunction (LVD) pose significant challenges in surgical decision-making.
• Accurate assessment of myocardial viability is crucial for optimizing outcomes in patients with reduced ejection fraction (EF).
• Radionuclide imaging techniques like SPECT and PET offer insights into myocardial perfusion and metabolism.

Purpose of the Study:

• To evaluate the utility of [18F]FDG/PET in identifying viable myocardium in patients with LVD considered for coronary surgery.
• To assess the impact of [18F]FDG/PET-guided surgical decisions on patient outcomes.
• To compare preoperative and postoperative myocardial perfusion and EF in different patient groups.

Main Methods:

• Seventy-four patients with LVD underwent [99mTc]MIBI/SPET for perfusion assessment and radionuclide angiography for EF.
• [18F]FDG/PET was performed in 44 patients under fasting and pharmacologic washout conditions to assess myocardial viability.
• Patients were categorized into three groups based on surgical intervention and FDG uptake: Group A (operated without PET), Group B (operated with FDG uptake), and Group C (excluded due to no FDG uptake).

Main Results:

• No significant differences in age, sex, CAD type, risk factors, or baseline EF were observed between Groups A, B, and C.
• Group C patients, showing no FDG uptake in dysfunctional segments, were excluded from surgery.
• Postoperative assessment of perfusion and EF was conducted 6 months after surgery for Groups A and B.

Conclusions:

• Preoperative [18F]FDG/PET imaging is valuable in selecting patients with LVD for coronary surgery by identifying viable myocardium.
• Exclusion of patients with absent FDG uptake in dysfunctional segments may prevent unnecessary surgical interventions.
• Further studies are needed to correlate these findings with long-term clinical outcomes.