Impact of diabetes mellitus on prediction of clinical outcome after coronary revascularization by 18F-FDG SPECT in patients with ischemic left ventricular dysfunction.

Abstract

UNLABELLED:

Nuclear imaging using (18)F-FDG is an established method for the noninvasive assessment of myocardial viability. Data on the value of (18)F-FDG imaging in patients with diabetes mellitus are scarce. The aim of this study was to assess whether, in patients with diabetes mellitus and ischemic left ventricular (LV) dysfunction, (18)F-FDG imaging can predict improvement of LV function and heart failure symptoms after coronary revascularization.

METHODS:

A total of 130 consecutive patients with ischemic LV dysfunction who were already scheduled for surgical revascularization were studied; 34 of the patients had diabetes mellitus. All patients underwent radionuclide ventriculography to assess left ventricular ejection fraction (LVEF), resting 2-dimensional echocardiography to identify dysfunctional myocardial tissue, and dual-isotope (18)F-FDG/(99m)Tc-tetrofosmin SPECT after oral administration of acipimox. Nine to 12 mo after coronary revascularization, radionuclide ventriculography and echocardiography were repeated. An improvement in LVEF by at least 5% was considered significant.

RESULTS:

(18)F-FDG SPECT demonstrated that 610 (50%) of 1,212 dysfunctional segments were viable. Patients with and without diabetes mellitus had a comparable number of dysfunctional but viable segments per patient. Also, the number of patients with a substantial amount of dysfunctional but viable myocardium (>or=4 viable segments) was comparable between the groups with and without diabetes mellitus. The presence of substantial viability on (18)F-FDG SPECT was predictive of improvement in LVEF and heart failure symptoms postoperatively (sensitivity and specificity of 82% and 89%, respectively, in patients with diabetes and 83% and 93%, respectively, in patients without diabetes; not statistically significant).

CONCLUSION:

(18)F-FDG SPECT is practical for routine assessment of myocardial viability in patients with ischemic LV dysfunction with or without diabetes mellitus. Patients with substantial myocardial viability on (18)F-FDG SPECT have a high probability of improvement of LV function and symptoms after coronary revascularization, irrespective of the absence or presence of diabetes mellitus.

• Authors: Arend F L Schinkel, Don Poldermans, Vittoria Rizzello, Ron T van Domburg, Roelf Valkema, Abdou Elhendy, Elena Biagini, Eric P Krenning, Maarten L Simoons, Jeroen J Bax
• Journal: Journal of nuclear medicine : official publication, Society of Nuclear Medicine (J Nucl Med) Vol. 47 Issue 1 Pg. 68-73 (Jan 2006) ISSN: 0161-5505 [Print] United States
• PMID: 16391189 (Publication Type: Controlled Clinical Trial, Journal Article)

Chemical References

• Radiopharmaceuticals
• Fluorodeoxyglucose F18

Topics

• Comorbidity
• Coronary Artery Bypass (statistics & numerical data)
• Diabetes Mellitus (diagnostic imaging, epidemiology, surgery)
• Female
• Fluorodeoxyglucose F18
• Humans
• Male
• Middle Aged
• Myocardial Ischemia (diagnostic imaging, epidemiology, surgery)
• Netherlands (epidemiology)
• Outcome Assessment, Health Care (methods)
• Prognosis
• Radiopharmaceuticals
• Risk Assessment (methods)
• Risk Factors
• Tomography, Emission-Computed, Single-Photon (methods)
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnostic imaging, epidemiology, surgery)