Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction.
BACKGROUND
The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a propensity analysis to determine whether there might be a survival advantage from revascularization.


RESULTS
We analyzed the survival of 765 consecutive patients (age 64+/-11 years, 80% men) with advanced left ventricular systolic dysfunction (ejection fraction < or =35%) and without significant valvular heart disease who underwent PET/FDG study at the Cleveland Clinic between 1997 and 2002. Early intervention was defined as any cardiac intervention (surgical or percutaneous) within the first 6 months of the PET/FDG study. In the entire cohort, 230 patients (30%) underwent early intervention (188 [25%] had open heart surgery, most commonly coronary artery bypass grafting, and 42 [5%] had percutaneous revascularization); 535 (70%) were treated medically. Using 39 demographic, clinical and PET/FDG variables, we were able to propensity-match 153 of the 230 patients with 153 patients who did not undergo early intervention. Among the propensity-matched group, there were 84 deaths during a median of 3 years follow-up. Early intervention was associated with a markedly lower risk of death (3-year mortality rate of 15% versus 35%, propensity adjusted hazard ratio 0.52, 95% CI 0.33 to 0.81, P=0.0004).


CONCLUSIONS
Among systolic heart failure patients referred for PET/FDG, early intervention may be associated with improved survival irrespective of the degree of viability.
Tarakji
Khaldoun G
KG
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Brunken
Richard
R
McCarthy
Patrick M
PM
Al-Chekakie
M Obadah
MO
Abdel-Latif
Ahmed
A
Pothier
Claire E
CE
Blackstone
Eugene H
EH
Lauer
Michael S
MS
D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D009204:Myocardial Revascularization / Q000401:mortality*; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D013599:Systole; D014022:Tissue Survival; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality
D019788:Fluorodeoxyglucose F18