Usefulness of Positron Emission Tomography in Predicting Long-Term Outcome in Patients With Diabetes Mellitus and Ischemic Left Ventricular Dysfunction

• Published in: The American journal of cardiology 2005-07, Vol.96 (1), p.2-8
• Main Authors: Sawada, Stephen, Hamoui, Omar, Barclay, Jennifer, Giger, Susan, Fain, Richard, Foltz, Judy, Fineberg, Naomi, Hutchins, Gary
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiac arrhythmia; Cardiology; Cardiology. Vascular system; Clinical outcomes; Diabetes; Diabetes Complications; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Long term; Male; Medical sciences; Middle Aged; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Risk Factors; Tomography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.03.028

We assessed the value of positron emission tomography to predict long-term outcome in patients with diabetes and ischemic left ventricular (LV) dysfunction. Circumferential profiles of nitrogen-13 ammonia (NH3) and fluorine-18 fluorodeoxyglucose uptakes were obtained in 61 patients who had diabetes and ischemic LV dysfunction. Patient profiles were compared with those from a normal database. NH3 and fluorine-18 fluorodeoxyglucose defect sizes and extent of perfusion-metabolism mismatch (percentage of myocardium with fluorine-18 fluorodeoxyglucose uptake minus NH3 uptake >2 SD above the normal difference) were determined. Patients were followed every 6 months. Over a mean follow-up of 4.3 years, cardiac death occurred in 52% of patients who underwent revascularization and 61% of those who underwent medical therapy (p = 0.69). No clinical or imaging variables predicted cardiac death in patients who underwent revascularization. In those who received medical therapy, mismatch in ≥3% of the left ventricle (risk ratio 4.0, p = 0.01) was the only multivariate predictor of cardiac death. Revascularization improved survival of patients who had mismatch of ≥3% at 4 years (p = 0.003) and at 8 years (p = 0.012) of follow-up. Patients who had mismatch ≥3% and ejection fraction