The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction

• Published in: The International Journal of Cardiovascular Imaging 2013-10, Vol.29 (7), p.1645-1653
• Main Authors: Uebleis, Christopher, Hellweger, Stefan, Laubender, Rüdiger Paul, Becker, Alexander, Sohn, Hae-Young, Lehner, Sebastian, Haug, Alexander, Bartenstein, Peter, Cumming, Paul, Van Kriekinge, Serge D., Slomka, Piotr J., Hacker, Marcus
• Format: Article
• Language: English
• Subjects: Cardiac Imaging; Cardiology; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - etiology; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Cardiomyopathies - therapy; Coronary Artery Bypass; Fluorodeoxyglucose F18; Humans; Imaging; Kaplan-Meier Estimate; Medicine; Medicine & Public Health; Myocardial Ischemia - complications; Myocardial Perfusion Imaging - methods; Myocardial Stunning - diagnostic imaging; Myocardial Stunning - etiology; Myocardial Stunning - physiopathology; Myocardium - pathology; Original Paper; Patient Selection; Percutaneous Coronary Intervention; Positron-Emission Tomography; Predictive Value of Tests; Radiology; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Time Factors; Tissue Survival; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Function, Left
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-013-0254-2

To evaluate the prognostic significance of combined myocardial perfusion SPECT and [18F]FDG PET viability scanning for the prediction of survival in patients with ischemic cardiomyopathy (iCMP) and left ventricular dysfunction. 244 patients (64.0 ± 10.6 years, 86 % men) with iCMP and LVEF ≤45 % underwent SPECT/PET. Percent scar tissue and SPECT/PET-mismatch (%-mismatch) were calculated and correlated with event-free survival according to the type of therapy (medical therapy with/out revascularization) provided after imaging. Death from any cause was defined as the primary endpoint. Early revascularization (ER) was performed in 113/244 (46 %) patients within 32 ± 52 days (26 bypass surgeries and 87 percutaneous coronary interventions). 65 patients died during follow-up for a median of 33 months. Kaplan–Meier analysis showed that those patients with ≥5 % mismatch not undergoing ER had significantly higher mortality than did the group with similar mismatch who did receive ER. Cox analysis identified both SPECT/PET-mismatch and the interaction of SPECT/PET-mismatch with ER as independent predictors for death due to all causes. A threshold of ≥5 % SPECT/PET-mismatch predicted best which patients with iCMP and LV dysfunction would benefit from ER in terms of long-term survival.