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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.

Cardiologia (Rome, Italy)
|April 1, 1993
PubMed
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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.

Related Experiment Videos

  • 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.