title: The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction.
abstract: To evaluate the prognostic significance of combined myocardial perfusion SPECT and [18F]FDG PET viability scanning for the prediction of survival in patients with ischemic cardiomyopathy (iCMP) and left ventricular dysfunction. 244 patients (64.0 ± 10.6 years, 86 % men) with iCMP and LVEF ≤ 45 % underwent SPECT/PET. Percent scar tissue and SPECT/PET-mismatch (%-mismatch) were calculated and correlated with event-free survival according to the type of therapy (medical therapy with/out revascularization) provided after imaging. Death from any cause was defined as the primary endpoint. Early revascularization (ER) was performed in 113/244 (46 %) patients within 32 ± 52 days (26 bypass surgeries and 87 percutaneous coronary interventions). 65 patients died during follow-up for a median of 33 months. Kaplan-Meier analysis showed that those patients with ≥ 5 % mismatch not undergoing ER had significantly higher mortality than did the group with similar mismatch who did receive ER. Cox analysis identified both SPECT/PET-mismatch and the interaction of SPECT/PET-mismatch with ER as independent predictors for death due to all causes. A threshold of ≥ 5 % SPECT/PET-mismatch predicted best which patients with iCMP and LV dysfunction would benefit from ER in terms of long-term survival.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Uebleis
authors.forename: Stefan
authors.initials: S
authors.lastname: Hellweger
authors.forename: Rüdiger Paul
authors.initials: RP
authors.lastname: Laubender
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Sohn
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lehner
authors.forename: Alexander
authors.initials: A
authors.lastname: Haug
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Paul
authors.initials: P
authors.lastname: Cumming
authors.forename: Serge D
authors.initials: SD
authors.lastname: Van Kriekinge
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D001026:Coronary Artery Bypass; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D017202:Myocardial Ischemia / Q000150:complications*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18