EFFECTS OF MYOCARDIAL VIABILITY ASSESSMENT WITH POSITRON EMISSION TOMOGRAPHY ON CLINICAL MANAGEMENT AND PATIENT OUTCOMES

Objective. To evaluate the effects of myocardial viability assessment with positron emission tomography on cardiac revascularization decisio n-making and consequential outcomes of patients with multivessel coron ary artery disease. Methods. Thirty-three patients with multivessel co ronary disease and heart failure were studied in this series, using (N H)-N-13 for myocardial perfusion and F-18-deoxy-glucose for myocardial metabolism. Viable myocardium (mismatched perfusion-metabolism) was v isually and quantitatively analyzed in anterior, apical, septal, infer ior, and lateral segments of the left ventricle. Left ventricular ejec tion fraction (LVEF) was also measured with first-pass radionuclide an giocardiography. Results. Based on the assessment of myocardial viabil ity, 19 patients (group A) with sufficient viable myocardium underwent revascularization (coronary bypass graft and/or angioplasty), and 14 patients (group B) without sufficient viable myocardium received conse rvative medical treatment. During an average of 17-month follow-up, th ere were 2 (10.5%) deaths in group A and 2 in group B (14.3%) deaths ( P>0.5). Patients with revascularization showed significantly improved average LVEFs post-revascularization, without revascularization proced ure-related mortality; patients with medical treatment had an initial average LVEF of 25% and class II-III (NYHA) average cardiac function w ith a survival rate of 86% in average, which was better than that repo rted in literature. Conclusion. Positron emission tomography is useful in myocardial viability assessment for cardiac revascularization deci sion-making through precisely selecting suitable patients for revascul arization and avoiding operations on those who will not benefit, which results in promising effects on outcomes of patients with multivessel coronary disease and severe left ventricular dysfunction.