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Division of Nuclear Medicine and Biophysics, Department of Molecular and Medical Pharmacology, University of California at Los Angeles School of Medicine, Los Angeles, California
Correspondence: For correspondence or reprints contact: Jamshid Maddahi, MD, Professor of Molecular and Medical Pharmacology, Director of Clinical PET Center, UCLA School of Medicine, CHS Room #AR-175, 10833 Le Conte Ave., Los Angeles, CA 90024-1721.
ABSTRACT
The reported mortality of patients with coronary artery disease (CAD) and congestive heart failure is high but variable. In the clinical management of these patients, the available treatment choices are medical therapy, cardiac transplantation and myocardial revascularization. Myocardial revascularization has become an attractive alternative in the management of patients with CAD and poor left ventricular function because medical therapy is associated with a high mortality and cardiac transplantation is expensive and not practical due to shortage of donor hearts. Myocardial revascularizatlon, however, should be recommended in those patients in whom the procedure is very likely to reverse regional and global left ventricular dysfunction and to improve heart failure symptoms and survival. Thallium-201 rest-redistribution myocardial scintigraphy and PET imaging of myocardial perfusion and 18F-fluoro-deoxyglucose metabolism have been extensively evaluated for the assessment of myocardial viability and for prediction of recovery of regional left ventricular dysfunction following myocardial revascularization; with positive and negative predictive accuracies of 72% and 70% for 201Tl rest-redistribution imaging and 83% and 84% for perfusion-metabolism PET imaging. Both modalities also are predictive of improvement in left ventricular ejection fraction after myocardial revascularization. Patients with congestive heart failure who demonstrate the PET pattern of mismatch are more likely to improve their heart failure symptoms following revascularization than those without the mismatch pattern. Furthermore, the PET pattern of mismatch identifies a subgroup of patients who are at very high risk for cardiac death on medical therapy. Survival of these patients can be significantly improved by myocardial revascularization.
Key Words: myocardial viability • left ventricular dysfunction • coronary artery disease • PET • thallium-201
FOOTNOTES
This paper was presented in part at the Annual Meeting of the Society of Nuclear Medicine on June 9, 1993, as part of a Continuing Medical Education Seminar organized by the Cardiovascular Council.
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