Prognostic value of 18Fe-FDG positron emission tomography in patients with coronary artery disease and left ventricular dysfunction

To evaluate the prognostic value of 18 F-FDG positron emission tomography (PET) in patients (pts) with coronary artery disease (CAD) and left ventricular dysfunction and to establish whether myocardial revascularization (RVS) will decrease the cardiac events in pts with perfusion-metabolism mismatch. 107 consecutive pts (mean age 57±9 yr) with CAD and left ejection fraction (LVEF=38±9%) who underwent 1'8F-FDG PET imaging and 99mTc-MIBI SPECT imaging were followed up for 24 ± 5 mons. Myocardial segments were classified as perfusion-metabolism mismatch (MM) and Match (M). LVEF and left ventricular end diastolic diameter (LVEDD) were measured with echocardiography (Echo). Fifty-nine pts underwent Echo, respectively. Cardiac death, myocardial infarction (MI), unstable angina pectoris and late RVS (>3 mon) were considered cardiac events. Among 64 patients with 2 or more MM segments, 35 pts received RVS (MM1) and 29 pts received medical therapy (MM2). Among 43 pts with less than 2 MM segment, 24 pts underwent RVS (M1) and 19 pts underwent medical therapy (M2). After RVS, LVEF in MM1 was increased from 38±8% to 48±10% (p<0.0001) in POS1 and to 52±10% (P<0.001) in POS2. LVEDD in MM1 was decreased form 62±8 mm to 53±7 mm (p<0.0001) in POS1 and to 53±8 mm (P<0.01) in POS2. However, LVEF and LVEDD were unchanged in M1 after RVS (P>0.05). The cardiac event rate of 51.7% (15/29) in MM2 was significantly higher than that of 2.9% (1/35) in MM1 (x2=20.1, p<0.0001), higher that of 16.7 %(3/24) in M1 (x2=7.02, P=0.002) and that of 21.1% in M2(x2=4.5, P=0.03). The results suggest that the presence of MM in pts with CAD and left ventricular dysfunction is associated with poor prognosis with medical therapy, and these pts may need aggressive RVS to prevent a future cardiac event and to improve left ventricular function