title: Positron emission tomography using(18)F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp: optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. Results from the European Community Concerted Action Multicenter study on use of(18)F-fluoro-deoxyglucose Positron Emission Tomography for the Detection of Myocardial Viability.
abstract: OBJECTIVE
  To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease.
  
  
  RESULTS
  One hundred and seventy-eight patients (157 male, 58+/-10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39+/-14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using(18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%).
  
  
  CONCLUSIONS
  In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.
authors.affiliation: Division of Cardiology and Positron Emission Tomography, University of Louvain, Brussels, Belgium.
authors.forename: B L
authors.initials: BL
authors.lastname: Gerber
authors.forename: F F
authors.initials: FF
authors.lastname: Ordoubadi
authors.forename: W
authors.initials: W
authors.lastname: Wijns
authors.forename: J L
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: M J
authors.initials: MJ
authors.lastname: Knuuti
authors.forename: M
authors.initials: M
authors.lastname: Janier
authors.forename: P
authors.initials: P
authors.lastname: Melon
authors.forename: P K
authors.initials: PK
authors.lastname: Blanksma
authors.forename: A
authors.initials: A
authors.lastname: Bol
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: J A
authors.initials: JA
authors.lastname: Melin
authors.forename: P G
authors.initials: PG
authors.lastname: Camici
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium; D001786:Blood Glucose / Q000378:metabolism*; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005387:Finland; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005602:France; D015309:Glucose Clamp Technique; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008131:London; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D009206:Myocardium / Q000378:metabolism; D009426:Netherlands; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D014055:Tomography, Emission-Computed; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18