Circulation, Vol 90, 2356-2366, Copyright © 1994 by American Heart Association
J vom Dahl, DT Eitzman, ZR al-Aouar, HL Kanter, RJ Hicks, GM Deeb, MM Kirsh and M Schwaiger
BACKGROUND--Imaging of myocardial glucose metabolism using
[18F]fluorodeoxyglucose (FDG) with positron emission tomography (PET) has
been proposed for identification of tissue viability in patients with
advanced coronary artery disease. This study was designed to evaluate the
predictive value of flow and metabolic imaging for functional recovery
after revascularization in myocardial segments of varying degrees of
dysfunction. METHODS AND RESULTS--Thirty-seven patients (mean age, 59 +/-
11 years) with coronary artery disease and impaired left ventricular
function (ejection fraction, 34 +/- 10%) were studied with PET using FDG
and [13N]ammonia before surgical coronary revascularization (3 +/- 1 grafts
per patient). Tissue was scintigraphically characterized as normal,
nonviable (concordant reduction of perfusion and FDG uptake), viable
without discordance of perfusion and metabolism (mildly reduced perfusion
and metabolism), or ischemically compromised (mismatch of reduced perfusion
and maintained FDG uptake). Functional outcome was assessed by serial
radionuclide ventriculography before and at 13 +/- 13 weeks (median
interval of 8 weeks) after coronary revascularization. Preoperatively
impaired regional wall motion improved significantly in ischemically
compromised (mismatch) revascularized segments but not in nonviable
myocardium or in viable myocardium without discordance of perfusion and
metabolism. The negative predictive value of PET for functional recovery
was 86%, whereas the positive predictive value in revascularized regions
ranged from 48% to 86% depending on severity of baseline wall motion
abnormalities. CONCLUSIONS--PET identifies metabolically active tissue,
which benefits from revascularization. Although the negative predictive
value of PET for recovery was high, functional improvement of viable but
ischemically compromised tissue was less frequent than previously reported.
The predictive value of PET was highest in left ventricular segments with
severe dysfunction and a mismatch or reduced perfusion but preserved
metabolism. Integration of PET, angiographic, and functional data is
necessary for the optimal selection of patients with advanced coronary
artery disease and impaired left ventricular function for
revascularization.
ARTICLES
Relation of regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization
Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor.
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