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Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor

Riemer HJA Slart, Clark J Zeebregts, Hans L Hillege, Johan De Sutter UGent, Rudi Dierckx UGent, Dirk J van Veldhuisen, Felix Zijlstra and Rene A Tio (2011) JOURNAL OF NUCLEAR MEDICINE. 52(6). p.873-879
abstract
Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 +/- 11 y (96 men, 23 women); global left ventricle MPR was 1.54 +/- 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
LEFT-VENTRICULAR DYSFUNCTION, positron emission tomography, POSITRON-EMISSION-TOMOGRAPHY, IDIOPATHIC DILATED CARDIOMYOPATHY, ISCHEMIC-HEART-DISEASE, NONINVASIVE QUANTIFICATION, BLOOD-FLOW, FLOW RESERVE, CORONARY INTERVENTION, GLUCOSE-UTILIZATION, PREDICTION, myocardial perfusion reserve, LV function, coronary artery disease, intervention, long-term outcome
journal title
JOURNAL OF NUCLEAR MEDICINE
J. Nucl. Med.
volume
52
issue
6
pages
873 - 879
Web of Science type
Article
Web of Science id
000291030000015
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
6.381 (2011)
JCR rank
1/116 (2011)
JCR quartile
1 (2011)
ISSN
0161-5505
DOI
10.2967/jnumed.110.084954
language
English
UGent publication?
no
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1930746
handle
http://hdl.handle.net/1854/LU-1930746
date created
2011-10-17 14:45:53
date last changed
2012-02-02 15:33:37
@article{1930746,
  abstract     = {Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 +/- 11 y (96 men, 23 women); global left ventricle MPR was 1.54 +/- 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95\% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95\% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.},
  author       = {Slart, Riemer HJA and Zeebregts, Clark J and Hillege, Hans L and De Sutter, Johan and Dierckx, Rudi and van Veldhuisen, Dirk J and Zijlstra, Felix and Tio, Rene A},
  issn         = {0161-5505},
  journal      = {JOURNAL OF NUCLEAR MEDICINE},
  keyword      = {LEFT-VENTRICULAR DYSFUNCTION,positron emission tomography,POSITRON-EMISSION-TOMOGRAPHY,IDIOPATHIC DILATED CARDIOMYOPATHY,ISCHEMIC-HEART-DISEASE,NONINVASIVE QUANTIFICATION,BLOOD-FLOW,FLOW RESERVE,CORONARY INTERVENTION,GLUCOSE-UTILIZATION,PREDICTION,myocardial perfusion reserve,LV function,coronary artery disease,intervention,long-term outcome},
  language     = {eng},
  number       = {6},
  pages        = {873--879},
  title        = {Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor},
  url          = {http://dx.doi.org/10.2967/jnumed.110.084954},
  volume       = {52},
  year         = {2011},
}

Chicago
Slart, Riemer HJA, Clark J Zeebregts, Hans L Hillege, Johan De Sutter, Rudi Dierckx, Dirk J van Veldhuisen, Felix Zijlstra, and Rene A Tio. 2011. “Myocardial Perfusion Reserve After a PET-driven Revascularization Procedure: a Strong Prognostic Factor.” Journal of Nuclear Medicine 52 (6): 873–879.
APA
Slart, R. H., Zeebregts, C. J., Hillege, H. L., De Sutter, J., Dierckx, R., van Veldhuisen, D. J., Zijlstra, F., et al. (2011). Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor. JOURNAL OF NUCLEAR MEDICINE, 52(6), 873–879.
Vancouver
1.
Slart RH, Zeebregts CJ, Hillege HL, De Sutter J, Dierckx R, van Veldhuisen DJ, et al. Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor. JOURNAL OF NUCLEAR MEDICINE. 2011;52(6):873–9.
MLA
Slart, Riemer HJA, Clark J Zeebregts, Hans L Hillege, et al. “Myocardial Perfusion Reserve After a PET-driven Revascularization Procedure: a Strong Prognostic Factor.” JOURNAL OF NUCLEAR MEDICINE 52.6 (2011): 873–879. Print.