TY - JOUR
T1 - Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure
T2 - A Strong Prognostic Factor
AU - Slart, Riemer H. J. A.
AU - Zeebregts, Clark J.
AU - Hillege, Hans L.
AU - de Sutter, Johan
AU - Dierckx, Rudi A. J. O.
AU - van Veldhuisen, Dirk J.
AU - Zijlstra, Felix
AU - Tio, Rene A.
PY - 2011/6/1
Y1 - 2011/6/1
N2 - Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 +/- 11 y (96 men, 23 women); global left ventricle MPR was 1.54 +/- 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
AB - Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 +/- 11 y (96 men, 23 women); global left ventricle MPR was 1.54 +/- 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
KW - positron emission tomography
KW - myocardial perfusion reserve
KW - LV function
KW - coronary artery disease
KW - intervention
KW - long-term outcome
KW - POSITRON-EMISSION-TOMOGRAPHY
KW - LEFT-VENTRICULAR DYSFUNCTION
KW - IDIOPATHIC DILATED CARDIOMYOPATHY
KW - ISCHEMIC-HEART-DISEASE
KW - FLOW RESERVE
KW - BLOOD-FLOW
KW - NONINVASIVE QUANTIFICATION
KW - CORONARY INTERVENTION
KW - GLUCOSE-UTILIZATION
KW - PREDICTION
U2 - 10.2967/jnumed.110.084954
DO - 10.2967/jnumed.110.084954
M3 - Article
VL - 52
SP - 873
EP - 879
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
SN - 0161-5505
IS - 6
ER -