Jj. Bax et al., Relationship between preoperative viability and postoperative improvement in LVEF and heart failure symptoms, J NUCL MED, 42(1), 2001, pp. 79-86
Citations number
28
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
The presence of myocardial viability is predictive of improvement in region
al left ventricular (LV) function after revascularization. Studies on predi
cting improvement in global LV function are scarce, and the amount of viabl
e myocardium needed for improvement in LV ejection fraction (LVEF) after re
vascularization is unknown. Moreover, whether the presence of viability is
associated with relief of heart failure symptoms after revascularization is
uncertain. Hence, the aims were to define the extent of Viable myocardium
needed for improvement in LVEF and to determine whether preoperative Viabil
ity testing can predict improvement in heart failure symptoms. Methods: Pat
ients (n = 47) with ischemic cardiomyopathy (mean LVEF +/- SD, 30% +/- 6%)
undergoing surgical revascularization were studied with F-18-FDG SPECT to a
ssess viability. Regional and global function were measured before and 3-6
mo after revascularization. Heart failure symptoms were graded according to
the New York Heart Association (NYHA) criteria, before and 3-6 mo after re
vascularization. Results: The number of viable segments per patient was dir
ectly related to the improvement in LVEF after revascularization (r = 0.79,
P < 0.01). Receiver operating characteristic curve analysis revealed that
the cutoff level of four viable segments (representing 31% of the left vent
ricle) yielded the highest sensitivity and specificity (86% and 92%, respec
tively) for predicting improvement in LVEF. Furthermore, the presence of fo
ur or more viable segments predicted improvement in heart failure symptoms
after revascularization, with positive and negative predictive Values of 76
% and 71%, respectively. Conclusion: The presence of substantial viability
(four or more viable segments, 31% of the left ventricle) on FDG SPECT is p
redictive of improvement in LVEF and heart failure symptoms postoperatively
.