Incremental prognostic value of left ventricular function by myocardial ECG-gated FDG PET imaging in patients with ischemic cardiomyopathy.
BACKGROUND
The purpose of this study was to determine the independent value of left ventricular (LV) functional parameters derived from gated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) to predict prognosis in patients with ischemic cardiomyopathy undergoing myocardial viability assessment.


RESULTS
We studied 90 consecutive patients with coronary artery disease and low LV ejection fraction (26% +/- 7%) undergoing gated FDG PET to assess myocardial viability for potential revascularization. The primary endpoint for this analysis was the occurrence of cardiac death, myocardial infarction, or worsening heart failure (HF) to New York Heart Association class IV. During follow-up (22 +/- 14 months), 21 patients had an event (17 died, 4 had myocardial infarctions, and 4 had worsening HF). On Cox regression analysis, the event-free survival rate at 2 years was lower for patients with an end-diastolic volume (EDV) of 260 mL or greater (relative risk, 2.7; P = .014), end-systolic volume (ESV) of 200 mL or greater (relative risk, 2.5; P = .021), and LV mass of 143 g or greater (relative risk, 1.6; P = .009). In a risk-adjusted model, EDV (chi 2 = 68, P < .0001) and ESV (chi 2 = 75, P = .035) added a significant amount in the estimation of events over the perfusion-FDG mismatch pattern (chi 2 = 40, P < .001). In a stratified Cox model, patients with PET mismatch, LV ejection fraction lower than 25%, and EDV of 260 mL or greater had the lowest survival rate (P = .006). These patients showed an apparent survival benefit with revascularization but without an improvement in HF symptoms.


CONCLUSIONS
LV functional parameters determined by gated FDG PET have incremental prognostic value over viability information in patients with ischemic cardiomyopathy. Our data suggest that patients with residual viability and advanced cardiac remodeling are at high clinical risk. In these patients the apparent survival benefit of revascularization may not be associated with a measurable improvement in HF symptoms.
Department of Radiology, Emory University of School of Medicine, Atlanta, GA 30322, USA. csantana@emory.edu
Cesar A
CA
Santana
Leslee J
LJ
Shaw
Ernest V
EV
Garcia
Marina
M
Soler-Peter
J
J
Candell-Riera
Gabriel B
GB
Grossman
Elizabeth G
EG
Krawczynska
Tracy L
TL
Faber
Aida
A
Ribera
Viola
V
Vaccarino
Raghuveer
R
Halkar
Marcelo F
MF
Di Carli
D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018572:Disease-Free Survival; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019788:Fluorodeoxyglucose F18; D015637:Gated Blood-Pool Imaging / Q000379:methods / Q000706:statistics & numerical data*; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18