Evaluation of Role of F-18 FDG Cardiac PET and Tc-99m Sestamibi Myocardial Perfusion Imaging in Assessing the Therapeutic Benefit in Patients with Coronary Artery Disease and Left Ventricular Systolic Dysfunction
(RSNA 2018, Sun Nov 25 2018 10:55AM - 11:05AM ROOM Z44)
To evaluate the therapeutic benefit with revascularization and optimal medical treatment (OMT) in patients diagnosed with hibernating myocardium on myocardial perfusion imaging (MPI) using F-18 FDG cardiac PET
METHOD AND MATERIALS
59 consecutive patients (43 males, 16 females, Mean Age 60.7 ± 9.4 years) with CAD and LV systolic dysfunction who underwent myocardial viability imaging for revascularization work-up and were diagnosed with hibernating myocardium were enrolled in this study. Patients were later treated with either revascularization or OMT and were followed for a median duration of 7.7 months for assessing the therapeutic benefit. Therapeutic benefit was assessed under 3 categories (a) Improvement in functional class (b) Adverse cardiac-events and (c) Improvement in LV function and myocardial perfusion on follow-up resting 99mTc-sestamibi myocardial perfusion imaging.
29 patients underwent revascularization (49%) and 25 patients received OMT (42%). Five patients were lost to follow-up. Patients were matched for baseline characteristics in both treatment arms. On follow-up, significant improvement was noted in NYHA functional class and CCS angina class post-revascularization. No such improvement was noted in the OMT group. The cardiac-event rate of patients in OMT group was significantly higher than that of patients in revascularization group (36% vs. 10.3 %; p = 0.046). At 1 year of follow-up, event-free survival in revascularization group was significantly superior compared to OMT group (83.8% vs. 50.8%; p= 0.039). On follow-up resting MPI scan, mean improvement in LVEF in revascularization group was significantly higher than in OMT group (6.0% vs. 1.4%; p=0.04).
Myocardial viability imaging is a sensitive modality to identify hibernating myocardium in patients with CAD and LV dysfunction and predicting its recovery following revascularization, thereby guiding the optimal treatment strategy for these patients.
Myocardial viability imaging should be performed prior to revascularization in patients with coronary artery disease with left-ventricular dysfunction to help predict recovery post-treatment.