| J Am Coll Cardiol 1992 Sep;20(3):559-565 |
Clinical outcome of patients with advanced coronary artery disease after
viability studies with positron emission tomography.
Eitzman D, al-Aouar Z, Kanter HL, vom Dahl J, Kirsh M, Deeb GM, Schwaiger M.
OBJECTIVE. The aim of this study was to determine the prognostic significance of
perfusion-metabolism imaging in patients undergoing positron emission tomography for
myocardial viability assessment. BACKGROUND. Positron emission tomography using
nitrogen-13 ammonia and 18fluorodeoxyglucose to assess myocardial blood flow and
metabolism has been shown to predict improvement in wall motion after coronary artery
revascularization. The prognostic implications of metabolic imaging in patients with
advanced coronary artery disease have not been investigated. METHODS. Eighty-two patients
with advanced coronary artery disease and impaired left ventricular function underwent
positron emission tomographic imaging between August 1988 and March 1990 to assess
myocardial viability before coronary artery revascularization. RESULTS. Forty patients
underwent successful revascularization. Patients who exhibited evidence of metabolically
compromised myocardium by positron emission tomography (decreased blood flow with
preserved metabolism) who did not undergo subsequent revascularization were more likely to
experience a myocardial infarction, death, cardiac arrest or late revascularization due to
development of new symptoms than were the other patient groups (p less than 0.01).
Concordantly decreased flow and metabolism in segments of previous infarction did not
affect outcome in patients with or without subsequent revascularization. Those with a
compromised myocardium who did undergo revascularization were more likely to experience an
improvement in functional class than were patients with preoperative positron emission
tomographic findings of concordant decrease in flow and metabolism. CONCLUSIONS. Positron
emission tomographic myocardial viability imaging appears to identify patients at
increased risk of having an adverse cardiac event or death. Patients with impaired left
ventricular function and positron emission tomographic evidence for jeopardized myocardium
appear to have the most benefit from a revascularization procedure.
