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(Circulation. 2006;113:230-237.)
© 2006 American Heart Association, Inc.

Heart Failure

Myocardial Viability Testing and the Effect of Early Intervention in Patients With Advanced Left Ventricular Systolic Dysfunction

Khaldoun G. Tarakji, MD; Richard Brunken, MD; Patrick M. McCarthy, MD; M. Obadah Al-Chekakie, MD; Ahmed Abdel-Latif, MD; Claire E. Pothier, MPH; Eugene H. Blackstone, MD; Michael S. Lauer, MD

From the Departments of Cardiovascular Medicine (K.G.T., C.E.P., M.S.L.), Medicine (O.A.-C., A.A.-L.), Nuclear Medicine (R.B.), and Cardiothoracic Surgery (P.M.M., E.H.B.), Cleveland Clinic Foundation, and the Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine (M.S.L.), Cleveland, Ohio.

Correspondence to Michael S. Lauer, MD, FACC, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195. E-mail Lauerm{at}ccf.org

Received February 8, 2005; revision received September 22, 2005; accepted September 27, 2005.

Background— The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a propensity analysis to determine whether there might be a survival advantage from revascularization.

Methods and Results— We analyzed the survival of 765 consecutive patients (age 64±11 years, 80% men) with advanced left ventricular systolic dysfunction (ejection fraction 35%) and without significant valvular heart disease who underwent PET/FDG study at the Cleveland Clinic between 1997 and 2002. Early intervention was defined as any cardiac intervention (surgical or percutaneous) within the first 6 months of the PET/FDG study. In the entire cohort, 230 patients (30%) underwent early intervention (188 [25%] had open heart surgery, most commonly coronary artery bypass grafting, and 42 [5%] had percutaneous revascularization); 535 (70%) were treated medically. Using 39 demographic, clinical and PET/FDG variables, we were able to propensity-match 153 of the 230 patients with 153 patients who did not undergo early intervention. Among the propensity-matched group, there were 84 deaths during a median of 3 years follow-up. Early intervention was associated with a markedly lower risk of death (3-year mortality rate of 15% versus 35%, propensity adjusted hazard ratio 0.52, 95% CI 0.33 to 0.81, P=0.0004).

Conclusions— Among systolic heart failure patients referred for PET/FDG, early intervention may be associated with improved survival irrespective of the degree of viability.

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Myocardial Viability Testing and the Effect of Early Intervention in Patients With Advanced Left Ventricular Systolic Dysfunction

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