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

Abstract

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.

The Value of Myocardium Perfusion Imaging in Assessment of Patients With Ischemic Cardiomyopathy

“…Пятилетние результаты исследования PARR-2 показали отсутствие разницы в частоте достижения комбинированной конечной точки между пациентами, которым выполняли или не выполняли ПЭТ сердца с 18F-ФДГ -53% пациентов из группы ПЭТ и 57% из группы стандартного обследования [90].…”

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

“…Viability study shows absence of 18F-FDG uptake in the apex, but partially preserved uptake elsewhere in the LAD territory indicating partially preserved viability. VLA vertical long axis, HLA horizontal long axis, SA short axis (adapted with permission from Springer Nature: Kiugel M) [87] assisted management improved outcomes in the subgroup of patients whose treatment adhered to the recommendations by imaging [89,90], especially in patients with a large amount of hibernating myocardium [91]. Similarly, an observational study evaluating survival benefit from revascularization according to the extent of ischemic, scarred, and viable myocardium found survival benefit from revascularization in patients with hibernating myocardium > 10% of the left ventricle [92].…”

The year in cardiology 2016: imaging

“…Ishodi nakon 5 godina nisu pokazali razlike u učestalosti zajedničkog ishoda (srčana smrt, infarkt miokarda ili hospitalizacija povezana sa srčanom bolesti): 53 % bolesnika s PET dijagnostikom u odnosu prema 57 % sa standardnom skrbi (HR 0,82, 95 % CI 0,62 -1,07; P = 0,15). 39 Ako se promatraju samo bolesnici koji su se držali preporuka snimanja PET-a s FDG-om, ishod se znatno poboljša-va u skupini skrbi potpomognutoj PET snimanjem (HR 0,73, 95 % CI 0,54 -0,99; P = 0,042). Navedeni rezultati upućuju na vrijednost procjene vijabilnosti miokarda pomoću PET-a u bolesnika s disfunkcijom LV-a uzrokovanom ishemijom, a koji su kandidati za revaskularizaciju.…”

“…39 However, if only patients who adhered to the recommendation of the FDG PET scan were included, the outcome was significantly improved in PET-assisted management (HR 0.73, 95% CI 0.54-0.99; P = 0.042). The results suggest that evaluation of myocardial viability with PET can aid in the decision making of patients with ischaemic LV dysfunction who are considered for revascularization.…”