Prediction of functional recovery after revascularization in patients with coronary artery disease and left ventricular dysfunction by gated FDG-PET.
BACKGROUND
Traditionally, cardiac fluorodeoxyglucose (FDG) uptake is combined with regional perfusion for optimal evaluation of viability. Gated FDG-positron emission tomography (PET) may be an alternative technique for detection of viability because it permits combined assessment of glucose metabolism uptake and wall thickening (WT). In this study the value of FDG uptake and WT (analyzed from a stand-alone gated FDG-PET study) for the prediction of recovery of regional and global left ventricular (LV) function in patients with coronary artery disease undergoing revascularization is studied.


RESULTS
Thirty-eight patients with chronic coronary artery disease and LV dysfunction were included. Patients underwent gated FDG-PET to assess viability. Magnetic resonance imaging was performed before and 6 months after revascularization to assess regional and global LV function and LV volumes. Of the 213 revascularized dysfunctional segments, 133 (62%) exhibited functional recovery on follow-up magnetic resonance imaging. Receiver operating characteristic curve analysis indicated that a cutoff level for FDG uptake of 50% or greater yielded a sensitivity and specificity of 93% and 85%, respectively, on gated FDG-PET for prediction of improvement in regional function. Similarly, a cutoff level of 10% or greater for WT was optimal with a sensitivity and specificity of 89% and 78%, respectively. Improvement in LV ejection fraction was best predicted by the number of viable segments. Reverse LV remodeling could be predicted with a sensitivity and specificity of 89% and 65%, respectively, by use of FDG uptake of 50% or greater and 78% and 70%, respectively, by use of WT of 10% or greater.


CONCLUSIONS
Accurate prediction of outcome after revascularization (including improvement in regional and global LV function and reverse remodeling) is possible with gated FDG-PET by use of a threshold of 50% or greater for FDG uptake or a threshold of 10% or greater for WT.
Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands. r.h.j.a.slart@nucl.umcg.nl
Riemer H J A
RH
Slart
Jeroen J
JJ
Bax
Dirk J
DJ
van Veldhuisen
Ernst E
EE
van der Wall
Rudi A
RA
Dierckx
Jaep
J
de Boer
Pieter L
PL
Jager
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D015637:Gated Blood-Pool Imaging / Q000379:methods; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D020127:Recovery of Function; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18