FDG-PET For Myocardial Viability Assessment: Does it Guide Decision Making For Revascularization In Real World Practice? A Single Center Experience

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

J Nucl Cardiol

Abstract

Introduction: The incidence of heart failure driven by ischemic heart disease is increasing. Intuitively it makes sense that identification of ischemic viable myocardium could drive revascularization decisions and survival, but recent study evidence has not favored it. We sought to evaluate if FDG PET guides real world decision making for revascularization in ischemic cardiomyopathy and if it makes a difference Methods: This is a retrospective chart review study of PET ischemia and viability testing performed between 2020-2024 at our institution; Patients’ baseline characteristics including comorbidities, ejection fraction and PET study results were evaluated. We compared baseline characteristics between positive viability and negative viability groups. Revascularization and changes in ejection fraction outcomes were assessed Results: Data of 111 patients who underwent PET ischemia and viability testing were analyzed; mean patients age is 69 yr old, M:F ratio 4:1, 64% white and 29% African American, all patients had HTN and HLD, 51 % diabetics and 53% were smoker. 78% of patients had a history of MI and 95% of patients have ischemic cardiomyopathy with a mean EF of 34%. The average SRS, SSS, SDS were 14, 13, 7 respectively. 99 patients received FDG for viability assessment. We found the following; First; 65 patients (67%) were positive for ischemic viable myocardium and 31 patients (31%) with non-viable myocardium. Second, there was no statistically significant difference in baseline characteristics of patients with positive viability and negative viability groups. Third, in the positive viability group (n=65); 37 patients (56%) had revascularization with PCI/CABG and 31 patients (43%) were treated medically and in the negative viability group, 19 patients (61%) were treated medically and only 11 patients (35%) received revascularization. Fourth, there is a significant improvement of the ejection fraction in the positive viability patients who underwent revascularization (mean baseline EF of 32%, mean post revascularization EF of 38% with P value =0.0004) and significant improvement in EF in the positive viability patient who were treated medically (mean baseline EF of 34%, mean EF post 3 months of medical therapy 37% with P value =0.005). Fifth, there is no significant improvement in the ejection fraction in the negative viability patients who underwent revascularization (mean baseline EF of 32%, mean post revascularization EF of 23% with P value =0.39). Finally, symptoms were reported to be improved in 36 patients (52%) in the viability positive group. Conclusion: - Our single center experience shows that clinicians continue to believe in viability assessment and refer patients for FDG-PET testing.-FDG-PET viability studies can be utilized to guide management and decision making of revascularization which can predict functional recovery and symptoms improvement

Volume

50

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