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      Utility of Positron Emission Tomography in Predicting Improved Left Ventricular Ejection Fraction after Coronary Artery Bypass Grafting among Patients with Ischemic Cardiomyopathy

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          Abstract

          The objective of this study was to determine whether preoperative estimates of regional myocardial uptake of <sup>18</sup>-F-fluorodeoxyglucose (FDG) could predict postoperative improvement in ejection fraction in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy. 20 consecutive patients [left ventricular ejection fraction (LVEF) ≤27%] were referred for preoperative positron emission tomography (PET) to measure regional myocardial FDG uptake and were deemed candidates for CABG. All individuals had technically adequate vessels and significant viability. The left anterior descending (LAD) coronary artery was severely diseased in all patients. Because of the importance of the anterior wall to overall ventricular performance, FDG uptake was semiquantitated in those regions and related to postoperative LVEF. 17 patients underwent CABG with an uneventful recovery. LVEF increased from 22 ± 4 to 26 ± 7% 2 weeks postsurgery (p < 0.05), with ≥5% change noted in 7 patients (group 1) and <5% noted in 10 patients (group 2). No preoperative or perioperative clinical variable could predict those with improved ventricular function. The relative amount of FDG uptake in the anterior wall was higher in group 1 compared with group 2 (93 ± 9 vs. 81 ± 13%; p < 0.05) and correlated with the change in LVEF post-CABG (r = 0.50; p < 0.05). >88% of FDG uptake in the LAD region had a positive predictive accuracy of 67% and negative predictive accuracy of 88% for improved LVEF postbypass. Late follow-up estimates of LVEF (median of 10 months) showed that early changes in function were sustained. In summary, among patients with severe coronary artery disease and depressed LVEF, ventricular function may improve early postrevascularization. PET estimates of relative FDG uptake in the anterior wall help predict those individuals who are likely to have the greatest increment in LVEF.

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          Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction.

          Patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction have a high but variable annual mortality and some may benefit from myocardial revascularization. This study aimed to evaluate the prognostic value of positron emission tomography (PET), and its interrelation with the choice of medical therapy or revascularization for predicting survival and improvement in symptoms of heart failure in patients with CAD and LV dysfunction. Ninety-three consecutive patients with angiographic CAD and a mean LV ejection fraction of 0.25 who underwent cardiac PET studies for assessment of hypoperfused yet viable myocardium ("mismatch pattern") using N-13 ammonia and 18-F deoxyglucose were followed up for an average of 13.6 months. Fifty patients underwent medical treatment and 43 underwent revascularization. The Cox model analysis showed that the extent of mismatch had a negative effect (p = 0.02), whereas revascularization had a positive effect on survival (p = 0.04). The annual survival probability of patients with mismatch receiving medical therapy was lower than of those without mismatch (50 vs 92%, p = 0.007). Patients with mismatch who underwent revascularization had a higher survival rate than those treated medically (88 vs 50%, P = 0.03). The presence of mismatch also predicted improvement in heart failure symptoms after revascularization (p < 0.001). These results suggest that the presence of mismatch in patients with CAD and severe LV dysfunction is associated with poor annual survival with medical therapy. Revascularization in patients with PET mismatch appears to be associated with improved survival and heart failure symptoms.
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            Left ventricular end-systolic volume index in patients with ischemic cardiomyopathy predicts postoperative ventricular function.

            We investigated the usefulness of the preoperative left ventricular end-systolic volume index (LVESVI) as a predictor of postoperative ventricular function.
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              Author and article information

              Journal
              CRD
              Cardiology
              10.1159/issn.0008-6312
              Cardiology
              S. Karger AG
              0008-6312
              1421-9751
              2000
              June 2000
              04 July 2000
              : 93
              : 1-2
              : 105-112
              Affiliations
              Divisions of Cardiology and Cardiovascular Surgery, VA Medical Center, University of Minnesota, Minneapolis, Minn., USA
              Article
              7010 Cardiology 2000;93:105–112
              10.1159/000007010
              10894915
              © 2000 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 4, Tables: 3, References: 24, Pages: 8
              Categories
              Noninvasive and Diagnostic Cardiology

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