Expedited Publication
F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction and Suspected Coronary Disease: A Randomized, Controlled Trial (PARR-2)

https://doi.org/10.1016/j.jacc.2007.09.006Get rights and content
Under an Elsevier user license
open archive

Objectives

We conducted a randomized trial to assess the effectiveness of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-assisted management in patients with severe ventricular dysfunction and suspected coronary disease.

Background

Such patients may benefit from revascularization, but have significant perioperative morbidity and mortality. F-18-fluorodeoxyglucose PET can detect viable myocardium that might recover after revascularization.

Methods

Included were patients with severe left ventricular (LV) dysfunction and suspected coronary disease being considered for revascularization, heart failure, or transplantation work-ups or in whom PET was considered potentially useful. Patients were stratified according to recent angiography or not, then randomized to management assisted by FDG PET (n = 218) or standard care (n = 212). The primary outcome was the composite of cardiac death, myocardial infarction, or recurrent hospital stay for cardiac cause, within 1 year.

Results

At 1 year, the cumulative proportion of patients who had experienced the composite event was 30% (PET arm) versus 36% (standard arm) (relative risk 0.82, 95% confidence interval [CI] 0.59 to 1.14; p = 0.16). The hazard ratio (HR) for the composite outcome, PET versus standard care, was 0.78 (95% CI 0.58 to 1.1; p = 0.15); for patients that adhered to PET recommendations for revascularization, revascularization work-up, or neither, HR = 0.62 (95% CI 0.42 to 0.93; p = 0.019); in those without recent angiography, for cardiac death, HR = 0.4 (95% CI 0.17 to 0.96; p = 0.035).

Conclusions

This study did not demonstrate a significant reduction in cardiac events in patients with LV dysfunction and suspected coronary disease for FDG PET-assisted management versus standard care. In those who adhered to PET recommendations and in patients without recent angiography, significant benefits were observed. The utility of FDG PET is best realized in this subpopulation and when adherence to recommendations can be achieved.

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CAD
coronary artery disease
CI
confidence interval
EF
ejection fraction
FDG
F-18-fluorodeoxyglucose
HR
hazard ratio
LV
left ventricle/ventricular
MI
myocardial infarction
MRI
magnetic resonance imaging
PET
positron emission tomography
RVG
radionuclide ventriculography

Cited by (0)

The study is supported by the Canadian Institutes for Health Research (CIHR grant MCT 37412) and the Heart and Stroke Foundation of Ontario (HSFO grants 4316 and 5222). The funding was supplemented by a University/Government/Industry Program: the Ontario Research and Development Challenge Fund with MDS Nordion, to provide part-time coordinator salary support. Dr. Beanlands was a Research Scientist supported by the Canadian Institutes for Health Research and a Premier’s Research Excellence Award. Dr. Nichol is the Medic One Foundation Endowed Chair in Prehospital Emergency Care.