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Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and left ventricular dysfunction: a PET/CT study

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Abstract

Sparse information is available on the role of cardiac viability imaging in elderly patients. We aimed at evaluating the prognostic value of FDG-PET/CT in elderly patients with stable coronary artery disease (CAD) and reduced left ventricular ejection fraction (rLVEF) before revascularisation. Elderly patients (> 65 years old, mean 74 ± 7 years old) with CAD and rLVEF were followed after cardiac FDG-PET/CT and stratified according to presence/absence of viable myocardium and subsequent revascularisation. Fatal events of any cause as well as hospitalisations related to acute cardiac conditions were reported as clinical end-points. Predictors of fatal events in patients with viable myocardium (> 1 myocardium segment/20) were analysed. A total of 89 patients were followed (64 viable myocardia; 37 and 27 patients with and without subsequent revascularisation, respectively). The change in LVEF during follow-up (2.1 ± 1.6 years) was 3.8 ± 6.6% (P = 0.013) and − 0.75 ± 2.6% (P = 0.170) in patients with and without revascularisation, respectively. Log-rank (P = 0.037) and multivariate analysis (Wald: 6.305, P = 0.012) showed viable myocardium to be significantly associated with fatal events if not revascularised. Elderly patients with viable myocardium might potentially benefit from revascularisation procedures as improved left ventricular ejection fraction and survival were observed in our retrospective study as compared to patients in whom a revascularisation procedure was denied. Viable myocardium as detected by cardiac FDG PET/CT was associated with better clinical outcomes in elderly patients when revascularised.

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Author notes

  1. Mehdi Namdar and Olivier Rager have contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, University Hospital Geneva, Geneva, Switzerland

    Mehdi Namdar, Angela Frei, Stephane Noble & René Nkoulou

  2. Division of Nuclear Medicine, University Hospital Geneva, Geneva, Switzerland

    Olivier Rager, Gael Amzalag, Osman Ratib & René Nkoulou

  3. Division of Internal Medicine, University Hospital Geneva, Geneva, Switzerland

    Julien Priamo

Authors
  1. Mehdi Namdar
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  2. Olivier Rager
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  3. Julien Priamo
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  4. Angela Frei
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  5. Stephane Noble
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  6. Gael Amzalag
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  7. Osman Ratib
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  8. René Nkoulou
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Correspondence to René Nkoulou.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Namdar, M., Rager, O., Priamo, J. et al. Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and left ventricular dysfunction: a PET/CT study. Int J Cardiovasc Imaging 34, 1673–1678 (2018). https://doi.org/10.1007/s10554-018-1380-7

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  • DOI: https://doi.org/10.1007/s10554-018-1380-7

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