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 journalArticle

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

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Left Ventricular Dysfunction
Angioplasty
Positron-Emission Tomography
Therapeutics
Arteries
Glucose Clamp Technique
Fluorodeoxyglucose F18
Coronary Artery Bypass
Echocardiography
Myocardium
Glucose

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Coronary angioplasty for the treatment of chronic left ventricular dysfunction : Predictive value of positron emission tomography. / Fath-Ordoubadi, F.; Beatt, K. J.; Spyrou, N.; Camici, P. G.

In: Heart, Vol. 77, No. SUPPL. 1, 05.1997.

Research output: Contribution to journalArticle

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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.",
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