CARDIAC82RUBIDIUM18F FDG-POSITRON EMISSION TOMOGRAPHY (PET) GUIDED REVASCULARIZATION OF CHRONIC TOTALLY OCCLUDED LESIONS: ISCHEMIA AND VIABILITY ASSESSMENT IS ALIVE AND WELL

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: Cardiac82Rubidium 18F FDG-PET imaging is widely regarded as the ideal imaging study to identify ischemic viable myocardium and guide clinical decision making in patients with coronary artery disease (CAD) where the risks and benefits of revascularization are unclear. However, trial data so far have cast doubts on the utility of viability imaging in CAD. Case: A 77-year-old male with CAD and prior CABG presented to the hospital with diaphoresis and chest pain. He underwent a pharmacologic single-photon emission computed tomography (SPECT) scan which showed a large area of infarct in the basal to mid left circumflex artery distribution, severe hypokinesis of the entire inferolateral wall and an ejection fraction of 50%. Given the infarct pattern on SPECT, he was treated with medical therapy. A few months later he was seen in the clinic with persistent anginal symptoms. Decision-making: A cardiac 82Rubidium 18F FDG-PET scan was ordered to further evaluate which showed a large area of ischemic viable myocardium in the left circumflex distribution with 27% of the myocardium showing hibernating physiology with no substantial infarct (Figure 1). Given symptoms with ischemic viable myocardium he subsequently underwent PCI to the proximal ramus intermedius artery with improvement in his angina. Conclusion: Cardiac82Rubidium 18F FDG-PET is a superior imaging modality when managing complex patients with CAD in identifying viable myocardium and suitability for revascularization.

Volume

83

Issue

13

First Page

3821

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