Coronary angioplasty for the treatment of chronic left ventricular dysfunction: Predictive value of positron emission tomography

F. Fath-Ordoubadi, K. J. Beatt, N. Spyrou, P. G. Camici

Research output: Contribution to journalArticlepeer-review

Abstract

Coronary artery bypass can restore function in hibernating myocardium (H). To ascertain whether coronary angioplasty (PTCA) is also effective in restoring function in H, we studied 15 patients [(pts), age: 62±9] with at least one chronically dysfunctional (D) segment (S) supplied by a stenotic artery. Myocardial viability was assessed with positron emission tomography (PET) and 18F-fluorodeoxyglucose during euglycemic hyperinsulinemic clamp. PET viability, based on our previous studies, was defined as a metabolic rate of glucose >0.25μmol/min/g in each S. Echocardiography was performed before and 4 months after PTCA. A total of 68 D-S were revascularised, 36 (53%) S improved after PTCA, 35 of which were PET viable (sensitivity: 97%), and 32 (47%) remained unchanged of which 25 were PET non-viable (specificity: 78%). However, 10 (33%) of unchanged S were found to be supplied by a restenosed artery of which 5 (50%) were PET viable. Exclusion of these S improved the specificity of PET to 90% and the positive predictive accuracy (PA) from 82% to 93%. Ejection fraction improved from 42±11% to 45±11% (p=0.08), the improvement became significant only if pts with restenosis were excluded (41±10% to 45±10%, p=0.04). Wall motion score improved from 1.48±0.28 to 1.39±0.41, (p=0.09) and only just fell to reach statistically significant after exclusion of restenosed pts (1.50±0.31 to 1.38±0.42, p=0.06). In conclusion: PTCA can improve the function in viable but D-S. Restenosis may hinder this recovery and lead to an apparently worse specificity and positive PA of PET.

Original languageEnglish
JournalHeart
Volume77
Issue numberSUPPL. 1
Publication statusPublished - May 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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