Positron emission tomography using 18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp

Optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction

B. L. Gerber, F. F. Ordoubadi, W. Wijns, J. L J Vanoverschelde, M. J. Knuuti, M. Janier, P. Melon, P. K. Blanksma, A. Bol, J. J. Bax, J. A. Melin, Paolo G. Camici

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Aims To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease. Methods and Results One hundred and seventy-eight patients (157 male, 58 ± 10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39 ± 14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%). Conclusions In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.

Original languageEnglish
Pages (from-to)1691-1701
Number of pages11
JournalEuropean Heart Journal
Volume22
Issue number18
DOIs
Publication statusPublished - 2001

Fingerprint

Glucose Clamp Technique
Deoxyglucose
Left Ventricular Dysfunction
Positron-Emission Tomography
Coronary Artery Disease
Sensitivity and Specificity
Angioplasty
Myocardium

Keywords

  • F-fluoro-2-deoxyglucose
  • Coronary artery disease
  • Euglycaemic hyperinsulinaemic glucose clamp
  • Myocardial viability
  • Positron emission tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Positron emission tomography using 18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp : Optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. / Gerber, B. L.; Ordoubadi, F. F.; Wijns, W.; Vanoverschelde, J. L J; Knuuti, M. J.; Janier, M.; Melon, P.; Blanksma, P. K.; Bol, A.; Bax, J. J.; Melin, J. A.; Camici, Paolo G.

In: European Heart Journal, Vol. 22, No. 18, 2001, p. 1691-1701.

Research output: Contribution to journalArticle

Gerber, B. L. ; Ordoubadi, F. F. ; Wijns, W. ; Vanoverschelde, J. L J ; Knuuti, M. J. ; Janier, M. ; Melon, P. ; Blanksma, P. K. ; Bol, A. ; Bax, J. J. ; Melin, J. A. ; Camici, Paolo G. / Positron emission tomography using 18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp : Optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. In: European Heart Journal. 2001 ; Vol. 22, No. 18. pp. 1691-1701.
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abstract = "Aims To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease. Methods and Results One hundred and seventy-eight patients (157 male, 58 ± 10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39 ± 14{\%}) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5{\%} improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79{\%}) and specificity (55{\%}) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45{\%} of normal remote myocardium (overall accuracy 67{\%}). Conclusions In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.",
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T1 - Positron emission tomography using 18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp

T2 - Optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction

AU - Gerber, B. L.

AU - Ordoubadi, F. F.

AU - Wijns, W.

AU - Vanoverschelde, J. L J

AU - Knuuti, M. J.

AU - Janier, M.

AU - Melon, P.

AU - Blanksma, P. K.

AU - Bol, A.

AU - Bax, J. J.

AU - Melin, J. A.

AU - Camici, Paolo G.

PY - 2001

Y1 - 2001

N2 - Aims To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease. Methods and Results One hundred and seventy-eight patients (157 male, 58 ± 10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39 ± 14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%). Conclusions In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.

AB - Aims To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease. Methods and Results One hundred and seventy-eight patients (157 male, 58 ± 10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39 ± 14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%). Conclusions In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.

KW - F-fluoro-2-deoxyglucose

KW - Coronary artery disease

KW - Euglycaemic hyperinsulinaemic glucose clamp

KW - Myocardial viability

KW - Positron emission tomography

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