Evaluation of Role of F-18 FDG Cardiac PET and Tc-99m Sestamibi Myocardial Perfusion Imaging in Assessing the Therapeutic Benefit in Patients with Coronary Artery Disease and Left Ventricular Systolic Dysfunction

(RSNA 2018, Sun Nov 25 2018 10:55AM – 11:05AM ROOM Z44)

PURPOSE

To evaluate the therapeutic benefit with revascularization and optimal medical treatment (OMT) in patients diagnosed with hibernating myocardium on myocardial perfusion imaging (MPI) using F-18 FDG cardiac PET

METHOD AND MATERIALS

59 consecutive patients (43 males, 16 females, Mean Age 60.7 ± 9.4 years) with CAD and LV systolic dysfunction who underwent myocardial viability imaging for revascularization work-up and were diagnosed with hibernating myocardium were enrolled in this study. Patients were later treated with either revascularization or OMT and were followed for a median duration of 7.7 months for assessing the therapeutic benefit. Therapeutic benefit was assessed under 3 categories (a) Improvement in functional class (b) Adverse cardiac-events and (c) Improvement in LV function and myocardial perfusion on follow-up resting 99mTc-sestamibi myocardial perfusion imaging.

RESULTS

29 patients underwent revascularization (49%) and 25 patients received OMT (42%). Five patients were lost to follow-up. Patients were matched for baseline characteristics in both treatment arms. On follow-up, significant improvement was noted in NYHA functional class and CCS angina class post-revascularization. No such improvement was noted in the OMT group. The cardiac-event rate of patients in OMT group was significantly higher than that of patients in revascularization group (36% vs. 10.3 %; p = 0.046). At 1 year of follow-up, event-free survival in revascularization group was significantly superior compared to OMT group (83.8% vs. 50.8%; p= 0.039). On follow-up resting MPI scan, mean improvement in LVEF in revascularization group was significantly higher than in OMT group (6.0% vs. 1.4%; p=0.04).

CONCLUSION

Myocardial viability imaging is a sensitive modality to identify hibernating myocardium in patients with CAD and LV dysfunction and predicting its recovery following revascularization, thereby guiding the optimal treatment strategy for these patients.

CLINICAL RELEVANCE/APPLICATION

Myocardial viability imaging should be performed prior to revascularization in patients with coronary artery disease with left-ventricular dysfunction to help predict recovery post-treatment.