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Clinical importance of viability assessment in chronic ischemic heart failure
W B Calhoun1, R M Mills, W E Drane
1University of Florida, College of Medicine, Gainesville 32610-0277, USA.
Insights
Assessing myocardial viability with fluorodeoxyglucose (F18DG) SPECT imaging helps guide treatment for patients with ischemic left ventricular dysfunction. This technique identified viable myocardium in over half of evaluated patients, influencing revascularization decisions.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Chronic ischemic left ventricular dysfunction often involves viable myocardium.
- Noninvasive techniques like dobutamine stress echo and F18DG scans assess myocardial viability.
- F18DG uptake assumes enhanced glucose metabolism indicates viable myocardium in areas of reduced blood flow.
Purpose of the Study:
- To determine the clinical utility of F18DG uptake scans in managing chronic ischemic left ventricular dysfunction.
- To evaluate the impact of viability assessment on treatment decisions for heart failure patients.
- To review findings and short-term outcomes of patients undergoing F18DG scans for viability.
Main Methods:
- Retrospective review of 59 F18DG viability studies in patients with coronary artery disease and depressed left ventricular function.
- Comparison of F18DG SPECT images with myocardial perfusion SPECT (thallium, sestamibi, or teboroxime).
- Analysis of clinical decisions, revascularization procedures, and 30-day mortality based on scan results.
Main Results:
- 58% (34 of 59) of patients showed evidence of viable myocardium.
- 29 patients underwent subsequent revascularization procedures.
- Thirty-day survival for revascularized patients was 86%.
Conclusions:
- F18DG SPECT imaging is valuable for assessing myocardial viability in ischemic left ventricular dysfunction.
- Viability assessment guided revascularization decisions in approximately half of the evaluated patients.
- This imaging modality aids in managing patients with severe coronary disease and left ventricular dysfunction.
Background And Hypothesis:
Revascularization has provided an effective treatment of depressed left ventricular function in patients with chronically ischemic or "viable" myocardium. Assessment of viable myocardium can be achieved by several noninvasive techniques including dobutamine stress echo or radionuclides such as flurodeoxyglucose (F18DG). F18DG uptake studies are based on the assumption that enhanced glucose uptake in areas of diminished blood flow provides evidence of viable myocardium. To determine the clinical utility of viability assessment in the management of chronic ischemic left ventricular dysfunction, we reviewed the findings and short-term treatment of a series of patients referred for heart failure evaluation who had subsequent F18DG uptake scans.
Methods:
We retrospectively reviewed 59 consecutive F18DG viability studies in a series of patients who had documented coronary artery disease and depressed left ventricular function. Single photon emission computerized tomography (SPECT) with F18DG was performed in the patients and these images were compared to SPECT images of resting myocardial perfusion using thallium, sestamibi, or teboroxime. Clinical decisions based on the results of these scans were obtained from chart review. Thirty-day mortality was determined from chart review or contact with the patient's physician. The patients were divided into those without and with F18DG uptake consistent with viable ischemic myocardium. Further analysis included subgroups of patients who were advised to undergo transplantation, revascularization, or to continue medical therapy.
Results:
Of 34 patients referred for cardiac transplantation, 18 had viable myocardium and 13 underwent revascularization. In the entire study group, 34 of 59 (58%) had evidence of viable myocardium and 29 had subsequent revascularization procedures. Thirty-day survival for all revascularization patients was 86%.
Conclusion:
Assessment of myocardial viability with F18DG SPECT imaging in patients with ischemic left ventricular dysfunction led to a clinical decision for revascularization in approximately half the patients with severe coronary disease and left ventricular dysfunction who were evaluated for myocardial viability in our institution.