Abstract 517: FDG PET Imaging Positively Impacts Management Direction and Predicts Outcomes in a Multicenter ‘Real World’ Setting
Background: Selection of candidates most likely to benefit from revascularization (REV) remains paramount in patients (pts) with ischemic heart failure (HF). Post-hoc analysis of PARR2 trial suggested an outcome benefit in subgroups of pts. Hence, a prospective provincial cardiac FDG PET registry has been established in Ontario. Our goal was to assess whether FDG PET impacts decision making and whether PET-defined hibernation predicts high risk pts.
Methods: A total of 264 pts were recruited (04/07– 05/09). Inclusion criteria:
LVEF ≥35%; potential candidate for REV or heart transplantation; and NYHA or CCS class II-IV; or
lack of viability on/equivocal other non-invasive testing. The primary outcome was the combined endpoint of cardiac death (CD), MI, arrest, or cardiac hospitalization.
Summary: Pts were: age: 65±10 years, male (82%), NYHA ≥ II (82%) and LVEF= 26%±8. To date,140 pts have completed at least 6 months and up to 2 years follow up (mean 369±164 days). A total of 45 pts had events (32%) with 7 pts suffering cardiac death (5%). REV was recommended in 54 pts and 42 pts (78%) underwent REV. In contrast, REV was not recommended in 58 pts and 7 pts (12%) underwent REV (p<0.01), indicating an impact of FDG PET on decision making. Pts with a mismatch score ≥7LV% who underwent REV compared to those who did not, had a significantly lower event rate (p<0.05, fig⇓).
Conclusions: The presence of substantial amounts of hibernating myocardium in pts with ischemic HF identifies potential candidates for REV and predicts adverse outcomes if those pts do not undergo REV. Results from this multicentre registry underscores the clinical usefulness of FDG PET in a ‘real world’ setting.