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[Myocardial revascularization in patients with compromised left ventricular function]
M A Mariani1, F Donatelli, S Pelenghi
1Istituto per le Malattie Cardiovascolari e Respiratorie, Università degli Studi, Istituto Scientifico H San Raffaele, Milano.
Insights
Preoperative [18F] FDG/PET imaging identifies viable myocardium in patients with coronary artery disease and left ventricular dysfunction, improving surgical outcomes and ejection fraction. This technique guides treatment decisions for better patient recovery.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) often leads to left ventricular dysfunction (LVD).
- Identifying viable myocardium is crucial for surgical decision-making in LVD patients.
- Positron Emission Tomography (PET) with [18F] FDG can assess myocardial viability.
Purpose of the Study:
- To evaluate the impact of preoperative [18F] FDG/PET on surgical outcomes in CAD patients with LVD.
- To compare outcomes between patients operated on with and without viability assessment.
- To assess the correlation between FDG uptake in akinetic segments and postoperative recovery.
Main Methods:
- Sixty-nine patients with CAD and LVD were analyzed.
- Myocardial viability was assessed using [18F] FDG/PET in 39 patients.
- Patients were divided into three groups: no preoperative PET (Group A), FDG uptake in akinetic segments (Group B), and no FDG uptake (Group C).
- Perfusion and ejection fraction (EF) were assessed using [99mTc] MIBI/SPET and radionuclide angiography.
- Outcomes including mortality, perioperative myocardial infarction, and intra-aortic balloon pump (IABP) use were compared.
Main Results:
- Group B (with FDG uptake) showed significantly lower IABP use (12.5%) compared to Group A (33.3%) (p = 0.048).
- Postoperative EF significantly improved in both Group A (p = 0.01) and Group B (p < 0.001).
- Group C patients with no viable myocardium were considered for heart transplantation.
Conclusions:
- Preoperative [18F] FDG/PET imaging is valuable for identifying viable myocardium in patients with LVD.
- Viability assessment can guide surgical decisions, potentially leading to improved postoperative ejection fraction and reduced need for IABP.
- Patients without viable myocardium may be candidates for heart transplantation.
Abstract:
From March 1988 to March 1992, 69 patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD) were referred to our Institute for surgical decision making. Sixty-nine (8.2%) had LVD. In 39/69 patients we performed the identification of viable myocardium with the use of [18F] FDG/PET in fasting conditions. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F] FDG/PET, Group B (32 patients) with FDG uptake in akinetic segments, and Group C (7 patients) with no FDG uptake; there was no significant difference among the 3 groups in age, sex, CAD, risk factors and ejection fraction EF (Group A: 29.1 +/- 6.6%, range 16-40; Group B: 32.9 +/- 6.5%, range 20-40; Group C: 26.5 +/- 6.8%, range 18-37). All patients underwent [99mTc] MIBI/SPET to assess perfusion at rest and [99mTc] MIBI first pass radionuclide angiography to assess the EF. The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Myocardial protection was achieved according to the Buckberg protocol. Operative results in Group A and B were respectively: in-hospital deaths 2 (6.6%) versus 0 (NS), perioperative myocardial infarction 1 (3.3%) versus 1 (3.1%) (NS), IABP 10 (33.3%) versus 4 (12.5%) (p = 0.048). Postoperative EF improved both in Group A (35.1 +/- 7.1%, range 20-50; p = 0.01) and in Group B (44.2 +/- 7.7%, range 26-62; p < 0.001). In Group C 6/7 patients were scheduled for heart transplantation according to standard criteria.(ABSTRACT TRUNCATED AT 250 WORDS)