EDMONTON, Alberta -- October 30, 2009 -- Fluorodeoxyglucose (FDG) positron-emission tomography (PET) identifies heart failure patients likely to benefit from revascularisation who would be otherwise missed, according to results of an analysis presented at the 2009 Canadian Cardiovascular Congress (CCC).
A prospective registry demonstrated in a real-world setting that FDG PET reveals hibernating myocardium, an indication for revascularisation based on previous evidence that patients with this finding have fewer adverse cardiac events if they receive an intervention.
"The results of this evaluation demonstrate that FDG PET imaging has a positive impact on decision making for revascularisation in patients with ischaemic heart failure," reported Maria Cecilia Ziadi, MD, University of Ottawa, Ottawa, Ontario, speaking here on October 27. Dr. Ziadi remarked that FDG PET is readily incorporated into management, and adds valuable information in a substantial proportion of patients.
Data were drawn from the Ontario Cardiac FDG PET Registry (CADRE) study, to which hospitals across the province of Ontario contribute. In this analysis, 128 heart-failure patients (New York Heart Association class II or III) with a left-ventricular ejection fraction of 35% or lower and over 6 months of follow-up were included. They were recruited over a 2-year period (April 2007 to April 2009). The diagnosis of hibernating myocardium on FDG PET was based on a mismatch score of 7 or greater in FDG uptake.
Of the 89 subjects without hibernating myocardium according to FDG PET, 62 were managed medically and 27 underwent revascularisation. The event rate at a follow-up of at least 6 months was not significantly different between these 2 groups (30.6% and 25.9%, respectively). Of the 39 who did have hibernating myocardium on the basis of FDG PET, all received a recommendation to undergo revascularisation but only 22 patients did so. The event rate was 27.3% in those who did undergo revascularisation, and 58.8% in those who did not (P = .047).
The results of the study appear to validate the recommendation for revascularisation in patients who are identified with hibernating myocardium.
"Selection of suitable candidates for revascularisation remains central to the management of ischaemic cardiomyopathy and heart failure," Dr. Ziadi noted, suggesting that FDG PET is a practical tool for guiding clinical decisions in this patient population.
The CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.
[Presentation title: Does FDG PET Imaging Impact Decision Making and Predict Outcomes? The Ontario Cardiac FDG PET Registry (CADRE) Study. Abstract 838]
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