Key result
Surgical revascularization linked to ~97% higher LVEF improvement rates vs medical therapy in viable myocardium.
Why the study?
The study was conducted to evaluate the utility of FDG PET myocardial viability assessment in patients with LV dysfunction, its role in therapeutic decision-making, and its impact on outcomes.
Does surgical revascularization improve LVEF and reduce cardiac events compared to medical therapy in patients with coronary artery disease, prior MI, and LV dysfunction who have viable myocardium on FDG PET?
Cohort (n=70)
Does surgical revascularization improve LVEF and reduce cardiac events compared to medical therapy in patients with coronary artery disease, prior MI, and LV dysfunction who have viable myocardium on FDG PET?
Absolute Event Rate: 89.8% vs 45.5%
p-value: p=0.002784
FDG PET viability imaging effectively identifies patients with ischemic cardiomyopathy who are likely to have improved LVEF and fewer cardiac events following surgical revascularization compared to medical therapy.
Warrants revascularization in viable myocardium for LVEF recovery; reinforces nuclear imaging to guide selection in ischemic HF.
AIM: To assess the utility of fluorodeoxyglucose (FDG) PET-based myocardial viability in patients with left ventricular (LV) dysfunction, its role in guiding therapeutic decision-making, and its impact on patient outcomes. MATERIALS AND METHODS: This retro-prospective study included 70 patients of coronary artery disease, with myocardial infarction and LV dysfunction [left ventricular ejection fraction (LVEF) ≤ 35%]. All patients underwent rest single-photon emission computerized tomography myocardial perfusion imaging and FDG PET cardiac viability imaging. Viability was assessed qualitatively and quantitatively as the percentage of viable hibernating myocardium. Patients were categorized as having predominantly viable myocardium (≥7% viable hibernating LV myocardium) or predominantly scarred myocardium (<7%). Management decisions included surgical revascularization or medical therapy. Outcomes at 6-month followup included improvement in LVEF (≥5%), cardiac events, and cardiac-related death. RESULTS: During follow up, two patients died of noncardiac causes. Among 68 patients (mean LVEF 25.58%), 88.2% (n = 60) had predominantly viable myocardium and 11.8% (n = 8) had scarred myocardium on FDG PET cardiac scan. Of viable patients, 89.8% (44/49) undergoing revascularization showed LVEF improvement at least 5% vs. 45.5% (5/11) medically managed (P = 0.002784). Cardiac events occurred in 4.1% vs. 27.3%, respectively (P = 0.039). No significant association was found between treatment type and outcomes in the scarred group (P = 0.464). CONCLUSION: FDG PET-based myocardial viability assessment can potentially play a role in guiding therapeutic decision-making in patients with LV dysfunction by identifying those with predominantly viable hibernating myocardium who are more likely to benefit from revascularization and have better outcomes in terms of improved LV function and fewer cardiac events compared to those managed medically.
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Singh et al. (2026) conducted a cohort in Coronary artery disease with myocardial infarction and LV dysfunction (n=70). Surgical revascularization vs. Medical therapy was evaluated on Improvement in LVEF (≥5%) at 6 months (p=0.002784). In patients with LV dysfunction and predominantly viable myocardium on FDG PET, surgical revascularization improved LVEF in 89.8% vs 45.5% with medical therapy (P=0.002784).
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