Key result
Myocardial viability assessment by FDG-PET showed no significant difference in overall survival among patients receiving CABG with ≥10% scar, CABG with <10% scar, or medical therapy (P=0.74).
Why the study?
The prognostic value of myocardial viability testing in patients with coronary artery disease and severe left ventricular dysfunction remains debated.
Does the extent of myocardial scar assessed by FDG-PET predict survival in patients with CAD and severe LV dysfunction undergoing CABG versus medical therapy?
Cohort (n=81)
Does the extent of myocardial scar assessed by FDG-PET predict survival in patients with CAD and severe LV dysfunction undergoing CABG versus medical therapy?
p-value: p=0.74
FDG-PET myocardial viability assessment has limited prognostic value for survival in patients with CAD and severe LV dysfunction, as functional recovery after surgical revascularization does not necessarily translate to survival benefits.
No survival difference by FDG-PET viability for CABG versus medical therapy; leaves open whether viability testing should guide decisions in CAD with severe LV dysfunction.
BACKGROUND: Myocardial viability assessment is typically performed in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction to identify those who might benefit from revascularization and assist in decision making process. However, the prognostic value of myocardial viability testing remains a debating issue. METHODS: FDG-PET) was performed in 81 patients with ischemic LV dysfunction [ejection fraction (EF) ≤35%] for myocardial viability assessment prior to coronary artery bypass surgery. Fifty-three of them received finally coronary artery bypass grafting and were divided into two groups according to the extent of myocardial scar: one group with scar burden ≥10% (n=30) and the other with scar burden <10% (n=23). The remaining patients were contraindicated for CABG and received optimal medical treatment (OMT, n=28). All patients were followed up and the primary endpoint was all-cause mortality and the secondary endpoint was a composite of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: FDG-PET revealed a different profile of myocardial viability among three groups with respect to the extent of myocardial scar, the hibernating myocardium (both P<0.01), some echocardiographic parameters such as left ventricular diastolic dimension (LVDD) and EF were also significantly different (both P<0.05). Nevertheless, the baseline prevalence of comorbidities and functional classifications were comparable. The per-procedural parameters were not significantly different between two CABG groups. In a median follow-up time of 32 months, Kaplan Meier analysis uncovered no significant difference in terms of overall survival (P=0.74) and MACCE-free survival (P=0.66) among three groups. CONCLUSIONS: FDG-PET is of limited prognostic value in patients with CAD and severe LV dysfunction. In patients with substantial myocardial scar burden despite the existence of considerable hibernating myocardium, functional recovery following surgical revascularization is not necessarily translated to survival benefits.
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Liu et al. (2018) conducted a cohort in Coronary artery disease and severe left ventricular dysfunction (n=81). Myocardial scar burden (≥10% vs <10%) and treatment strategy (CABG vs OMT) vs. Compared among three groups was evaluated on All-cause mortality (p=0.74). Myocardial viability assessment by FDG-PET showed no significant difference in overall survival among patients receiving CABG with ≥10% scar, CABG with <10% scar, or medical therapy (P=0.74).
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