Identification of Therapeutic Benefit from Revascularization in Patients With Left Ventricular Systolic Dysfunction

Ling, Lee Fong; Marwick, Thomas H.; Flores, D; Jaber, Wael A.; Brunken, Richard C.; Cerqueira, Manuel D.; Hachamovitch, Rory

doi:10.1161/circimaging.112.000138

Cited by 173 publications

(109 citation statements)

References 31 publications

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“…Furthermore, the modalities used for imaging were dobutamine echocardiography and single photon emission computed tomography perfusion imaging which, although widely available, have lower sensitivity for hibernating myocardium than FDG PET, for which the extent of hibernating myocardium has also been shown to be a strong predictor of outcome benefit. [12][13][14][15]20,21 Finally, the patient population in the STICH trial differed from those in the PARR-2 study, in that the STICH population was younger, and had lower prevalence of prior CABG, renal dysfunction, and 3-vessel CAD (among those with angiography). 22 Therefore, the incremental value of the results of viability imaging was less because many of the patients in the STICH trial were already good candidates for CABG (having suitable anatomy was a requirement for inclusion).…”

Section: Discussionmentioning

confidence: 98%

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease

Ardle

Shukla

Nichol

et al. 2016

Circ: Cardiovascular Imaging

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I schemic cardiomyopathy remains a significant cause of morbidity and mortality, despite advances in pharmacological and device therapy over the past 3 decades. 1,2 There is a large body of predominantly observational data to demonstrate that restoration of blood flow to dysfunctional myocardium in the territory of a stenosed coronary artery is beneficial, [3][4][5] but controversies remain regarding surgical revascularization, Background-Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)-assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed. Long-term outcomes of viability imaging-assisted management have not previously been evaluated in a randomized controlled trial. Methods and Results-PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62-1.07]; P=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54-0.99; P=0.042). Conclusions-After a 5-year follow-up in patients with left ventricular dysfunction and suspected CAD, overall, PETassisted management did not significantly reduce cardiac events compared with standard care. However, significant benefits were observed when there was adherence to PET recommendations. PET viability imaging may be best applied when there is likely to be adherence to imaging-based recommendations. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00385242.(Circ Cardiovasc Imaging. 2016;9:e004331.

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Section: Discussionmentioning

confidence: 98%

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease

Ardle

Shukla

Nichol

et al. 2016

Circ: Cardiovascular Imaging

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“…[25,26] A 2013 study from the Cleveland Clinic reported outcomes for 648 consecutive ischaemic cardiomyopathy patients who underwent perfusion and metabolic imaging by PET. [26] Patients had a mean ejection fraction of 31%, and early revascularisation (within 92 days) was performed in 199 patients (33%). Patients were followed up for an average of 2.8 years for a primary endpoint of all-cause mortality.…”

Section: Viability Testing In Clinical Practice: Observational Seriesmentioning

confidence: 99%

“…[27] PARR-2 enrolled patients with severe left ventricular dysfunction and suspected coronary artery disease being considered for revascularisation or transplantation, and randomised them to FDG-PET imaging (n = 218) or stan- [26] dard of care (n = 212). The primary endpoint was a composite of cardiac death, MI or recurrent hospital stay.…”

Section: Parr-2 Trialmentioning

confidence: 99%

Viability testing to guide myocardial revascularisation in patients with heart failure

Cahill

Kharbanda

2018

Indian J Thorac Cardiovasc Surg

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Myocardial revascularisation has the potential to restore ventricular function and improve survival in patients with heart failure due to underlying coronary artery disease. Viability testing is routinely used to identify which patients are likely to benefit, given that revascularisation may entail substantial procedural risk. However, while the concept of viability testing and revascularisation of patients with 'hibernating myocardium' is strongly supported by observational series, randomised studies have failed to demonstrate clear benefit. This divergence in the evidence base is reflected in current European and US guidelines, in which viability testing has a class II recommendation. In this article, we review the current evidence for routine viability testing prior to revascularisation of patients with heart failure, outline its use in clinical practice and discuss ongoing trials in the field.

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“…33 (patients undergoing early revascularization within 92 days of PET were excluded from analysis to avoid ''waiting-time'' bias).…”

Section: Pet: Hibernating (Viable) Myocardium Vs Inducible Ischemia Amentioning

confidence: 99%

Noninvasive assessment myocardial viability: Current status and future directions

Allman

2013

Journal of Nuclear Cardiology

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Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.

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Identification of Therapeutic Benefit from Revascularization in Patients With Left Ventricular Systolic Dysfunction

Cited by 173 publications

References 31 publications

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease

Viability testing to guide myocardial revascularisation in patients with heart failure

Noninvasive assessment myocardial viability: Current status and future directions

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