(Circulation. 1995;92:3436-3444.)
© 1995 American Heart Association, Inc.
Articles |
Quantitative Relation Between Myocardial Viability and Improvement in Heart Failure Symptoms After Revascularization in Patients With Ischemic Cardiomyopathy
From the Division of Nuclear Medicine, Department of Medical and Molecular Pharmacology, Laboratory of Nuclear Medicine, Laboratory of Biomedical and Environmental Sciences; the Crump Institute for Biological Imaging; and the Division of Cardiothoracic Surgery (H.L.), Department of Surgery, University of California at Los Angeles, School of Medicine.
Correspondence to Marcelo F. Di Carli, MD, Positron Emission Tomography Center, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201-2196. E-mail: mdicarli@pet.wayne.edu.
Background Studies of patients with coronary artery disease and left ventricular dysfunction have shown that preoperative quantification of myocardial viability may be clinically useful to identify those patients who will benefit most from revascularization both functionally and prognostically. However, the relation between preoperative extent of viability and change in heart failure symptoms has not been documented carefully. We assessed the relation between the magnitude of improvement in heart failure symptoms after coronary artery bypass surgery (CABG) and the extent of myocardial viability as assessed by use of quantitative analysis of preoperative positron emission tomography (PET) images.
Methods and Results We studied 36 patients with
ischemic cardiomyopathy (mean left
ventricular ejection fraction, 28±6%) undergoing CABG.
Preoperative extent and severity of perfusion abnormalities and
myocardial viability (flow-metabolism mismatch) were
assessed by use of quantitative analysis of PET images with
13N ammonia and fluorine-18-deoxyglucose. Each patient's
functional status was determined before and after CABG by use of a
Specific Activity Scale. Mean perfusion defect size and severity were
63±13% and 33±12%, respectively. Total extent of a PET mismatch
correlated linearly and significantly with percent improvement in
functional status after CABG (r=.87,
P<.0001). A blood flow–metabolism
mismatch 
18% was associated with a sensitivity of 76% and a
specificity of 78% for predicting a change in functional status after
revascularization. Patients with large mismatches
(18%) achieved a significantly higher functional status compared
with those with minimal or no PET mismatch (<5%) (5.7±0.8 versus
4.9±0.7 metabolic equivalents, P=.009).
This resulted in an improvement of 107% in patients with large
mismatches compared with only 34% in patients with minimal or no PET
mismatch.
Conclusions In patients with ischemic cardiomyopathy, the magnitude of improvement in heart failure symptoms after CABG is related to the preoperative extent and magnitude of myocardial viability as assessed by use of PET imaging. Patients with large perfusion-metabolism mismatches exhibit the greatest clinical benefit after CABG.
Key Words: cardiomyopathy • myocardium • revascularization • tomography
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M. Gheorghiade and R. O. Bonow Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease Circulation, January 27, 1998; 97(3): 282 - 289. [Full Text] [PDF]
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