Impact of diabetes mellitus on prediction of clinical outcome after coronary revascularization by 18F-FDG SPECT in patients with ischemic left ventricular dysfunction.
Nuclear imaging using (18)F-FDG is an established method for the noninvasive assessment of myocardial viability. Data on the value of (18)F-FDG imaging in patients with diabetes mellitus are scarce. The aim of this study was to assess whether, in patients with diabetes mellitus and ischemic left ventricular (LV) dysfunction, (18)F-FDG imaging can predict improvement of LV function and heart failure symptoms after coronary revascularization.


METHODS
A total of 130 consecutive patients with ischemic LV dysfunction who were already scheduled for surgical revascularization were studied; 34 of the patients had diabetes mellitus. All patients underwent radionuclide ventriculography to assess left ventricular ejection fraction (LVEF), resting 2-dimensional echocardiography to identify dysfunctional myocardial tissue, and dual-isotope (18)F-FDG/(99m)Tc-tetrofosmin SPECT after oral administration of acipimox. Nine to 12 mo after coronary revascularization, radionuclide ventriculography and echocardiography were repeated. An improvement in LVEF by at least 5% was considered significant.


RESULTS
(18)F-FDG SPECT demonstrated that 610 (50%) of 1,212 dysfunctional segments were viable. Patients with and without diabetes mellitus had a comparable number of dysfunctional but viable segments per patient. Also, the number of patients with a substantial amount of dysfunctional but viable myocardium (>or=4 viable segments) was comparable between the groups with and without diabetes mellitus. The presence of substantial viability on (18)F-FDG SPECT was predictive of improvement in LVEF and heart failure symptoms postoperatively (sensitivity and specificity of 82% and 89%, respectively, in patients with diabetes and 83% and 93%, respectively, in patients without diabetes; not statistically significant).


CONCLUSIONS
(18)F-FDG SPECT is practical for routine assessment of myocardial viability in patients with ischemic LV dysfunction with or without diabetes mellitus. Patients with substantial myocardial viability on (18)F-FDG SPECT have a high probability of improvement of LV function and symptoms after coronary revascularization, irrespective of the absence or presence of diabetes mellitus.
Schinkel
Arend F L
AF
Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. arendschinkel@hetnet.nl
Poldermans
Don
D
Rizzello
Vittoria
V
van Domburg
Ron T
RT
Valkema
Roelf
R
Elhendy
Abdou
A
Biagini
Elena
E
Krenning
Eric P
EP
Simoons
Maarten L
ML
Bax
Jeroen J
JJ
D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18