Long-term survival of patients with viable and nonviable aneurysms assessed by 99mTc-MIBI SPECT and 18F-FDG PET: a comparative study of medical and surgical treatment.
The prognostic value of myocardial viability assessment on left ventricular (LV) aneurysms remains undetermined. We aimed, first, to evaluate the long-term survival benefit of assessing the viability of the aneurysmal myocardium in patients with ischemic cardiomyopathy and, second, in the revascularization subgroup, to compare the short-term effects on LV function and clinical symptoms in patients treated by revascularization alone or by revascularization plus aneurysmectomy.


METHODS
Seventy consecutive patients with an LV aneurysm who underwent 99mTc-sestamibi SPECT and 18F-FDG PET were followed up for a median of 6.8 y (range, 0.1-8.8 y). Only cardiac death during follow-up served as the endpoint. Patients were classified into 4 groups by aneurysmal viability and by treatment strategy (medical or surgical). Further, the effects of aneurysmectomy on LV function at 3 mo were evaluated by an analysis of revascularized patients grouped by aneurysmal viability and by aneurysmectomy.


RESULTS
Twenty-four patients were assigned to medical therapy, and 46 patients were assigned to surgery (18 revascularization alone and 28 revascularization plus aneurysmectomy). The annual cardiac mortality rate in patients with a viable aneurysm treated medically (n = 10) was significantly higher than that in patients with a viable aneurysm treated surgically (n = 23) (11.6% vs. 1.5%, chi2 = 12.87, P < 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n = 14) (chi2 = 4.13, P < 0.05) or surgically (n = 23) (chi2 = 10.46, P = 0.001). Multivariate analysis showed that the aneurysmal mismatch score (P = 0.003) and surgical therapy (P = 0.001) were independent predictors of cardiac death. Improvement of LV function and symptoms after revascularization (P < 0.05) was observed in patients with revascularization plus aneurysmectomy and in patients with a viable aneurysm and revascularization only.


CONCLUSIONS
Viability in LV aneurysm in patients with ischemic cardiomyopathy was a negative independent predictor of survival. Compared with medical therapy, coronary revascularization was associated with improved long-term survival, symptoms, and LV function in patients with a viable aneurysm. These findings warrant further prospective investigations.
Zhang
Xiaoli
X
Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. xlzhang416@gmail.com
Liu
Xiu-jie
XJ
Hu
Shengshou
S
Schindler
Thomas H
TH
Tian
Yueqing
Y
He
Zuo-xiang
ZX
Gao
Runlin
R
Wu
Qingyu
Q
Wei
Hongxing
H
Sayre
James W
JW
Schelbert
Heinrich R
HR
D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi