Author + information
- Received October 28, 1991
- Revision received February 3, 1992
- Accepted March 5, 1992
- Published online September 1, 1992.
- Daniel Eitzman, MD,
- Ziad Al-Aouar, MD,
- Harry Lee Kanter, MD,
- Juergen vom Dahl, MD,
- Marvin Kirsh, MD,
- George Michael Deeb, MD and
- Markus Schwaiger, MD, FACC∗
- ↵∗Address for correspondence: Markus Schwaiger, MD, Department of Internal Medicine, University of Michigan Medical Center, 1500 East Medical Center Drive, UH BIG505, Ann Arbor, Michigan 48109-0028.
Objective. The aim of this study was to determine the prognostic significance of perfusion-metabolism imaging in patients undergoing positron emission tomography for myocardial viability assessment.
Background. Positron emission tomography using nitrogen-13 ammonia and 18fluorodeoxyglucose to assess myocardial blood flow and metabolism has been shown to predict improvement in wall motion after coronary artery revascularization. The prognostic implications of metabolic imaging in patients with advanced coronary artery disease have not been investigated.
Methods. Eighty-two patients with advanced coronary artery disease and impaired left ventricular function underwent positron emission tomographic imaging between August 1988 and March 1990 to assess myocardial viability before coronary artery revascularization.
Results. Forty patients underwent successful revascularization. Patients who exhibited evidence of metabolically compromised myocardium by positron emission tomography (decreased blood flow with preserved metabolism) who did not undergo subsequent revascularization were more likely to experience a myocardial infarction, death, cardiac arrest or late revascularization due to development of new symptoms than were the other patient groups (p < 0.01). Concordantly decreased flow and metabolism in segments of previous infarction did not affect outcome in patients with or without subsequent revascularization. Those with a compromised myocardium who did undergo revascularization were more likely to experience an improvement in functional class than were patients with preoperative positron emission tomographic findings of concordant decrease in flow and metabolism.
Conclusions. Positron emission tomographic myocardial viability imaging appears to identify patients at increased risk of having an adverse cardiac event or death. Patients with impaired left ventricular function and positron emission tomographic evidence for jeopardized myocardium appear to have the most benefit from a revascularization procedure.
☆ This work was performed during the tenure of an Established Investigatorship of Dr. Schwaiger from the American Heart Association, Dallas, Texas and was supported in part by Grant RO1 HL41047 from the National Institutes of Health, Bethesda, Maryland and Grant DE-FG02-90ER61091 from the Department of Energy, Washington, D.C.
- Received October 28, 1991.
- Revision received February 3, 1992.
- Accepted March 5, 1992.