Relation of regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization

Relation of regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization

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 metabo...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) Vol. 90; no. 5; pp. 2356 - 2366
Main Authors: VOM DAHL, J, EITZMAN, D. T, AL-AOUAR, Z. R, KANTER, H. L, HICKX, R. J, DEEB, G. M, KIRSH, M. M, SCHWAIGER, M
Format: Journal Article
Language:English
Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-1994
American Heart Association, Inc
Subjects:
Adult
Aged
Biological and medical sciences
Cardiology. Vascular system
Coronary Disease - physiopathology
Coronary Disease - surgery
Coronary heart disease
Female
Glucose - metabolism
Heart
Humans
Male
Medical sciences
Middle Aged
Myocardial Revascularization
Myocardium - metabolism
Perfusion
Tomography, Emission-Computed
Ventricular Function, Left
Radionuclide study
Human
Cardiac performance
Cardiovascular disease
Exploration
Coronary heart disease
Treatment
Aortocoronary
Bypass
Surgery
Ejection fraction
Positron
Emission tomography
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Summary: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. 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. 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.
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ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.90.5.2356