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The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction

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Abstract

To evaluate the prognostic significance of combined myocardial perfusion SPECT and [18F]FDG PET viability scanning for the prediction of survival in patients with ischemic cardiomyopathy (iCMP) and left ventricular dysfunction. 244 patients (64.0 ± 10.6 years, 86 % men) with iCMP and LVEF ≤45 % underwent SPECT/PET. Percent scar tissue and SPECT/PET-mismatch (%-mismatch) were calculated and correlated with event-free survival according to the type of therapy (medical therapy with/out revascularization) provided after imaging. Death from any cause was defined as the primary endpoint. Early revascularization (ER) was performed in 113/244 (46 %) patients within 32 ± 52 days (26 bypass surgeries and 87 percutaneous coronary interventions). 65 patients died during follow-up for a median of 33 months. Kaplan–Meier analysis showed that those patients with ≥5 % mismatch not undergoing ER had significantly higher mortality than did the group with similar mismatch who did receive ER. Cox analysis identified both SPECT/PET-mismatch and the interaction of SPECT/PET-mismatch with ER as independent predictors for death due to all causes. A threshold of ≥5 % SPECT/PET-mismatch predicted best which patients with iCMP and LV dysfunction would benefit from ER in terms of long-term survival.

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Abbreviations

ACD:

All cause death

AUC:

Area under the curve

CABG:

Coronary artery bypass graft

CD:

Cardiac death

CR:

Cardiac revascularization

ER:

Early revascularization

iCMP:

Ischemic cardiomyopathy

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

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Acknowledgments

A substantial part of this work originated from the doctoral thesis of cand. med. Stefan Hellweger.

Conflict of interest

Cedars-Sinai Medical Center receives royalties for the licensure of software used in the quantitative assessment of function, perfusion, and viability, a portion of which is distributed to some of the authors of this article.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Christopher Uebleis, Stefan Hellweger, Sebastian Lehner, Alexander Haug, Peter Bartenstein, Paul Cumming & Marcus Hacker

  2. Institute of Medical Informatics, Biometry, and Epidemiology (IBE), University of Munich, Munich, Germany

    Rüdiger Paul Laubender

  3. Medical Department I, University of Munich, Munich, Germany

    Alexander Becker & Hae-Young Sohn

  4. Cedars-Sinai Medical Center, Los Angeles and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Serge D. Van Kriekinge & Piotr J. Slomka

Authors
  1. Christopher Uebleis
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  2. Stefan Hellweger
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  3. Rüdiger Paul Laubender
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  4. Alexander Becker
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  5. Hae-Young Sohn
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  6. Sebastian Lehner
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  7. Alexander Haug
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  8. Peter Bartenstein
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  9. Paul Cumming
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  10. Serge D. Van Kriekinge
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  11. Piotr J. Slomka
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  12. Marcus Hacker
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Corresponding author

Correspondence to Marcus Hacker.

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Uebleis, C., Hellweger, S., Laubender, R.P. et al. The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction. Int J Cardiovasc Imaging 29, 1645–1653 (2013). https://doi.org/10.1007/s10554-013-0254-2

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  • DOI: https://doi.org/10.1007/s10554-013-0254-2

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