TY - JOUR
T1 - Long-term survival of patients with viable and nonviable aneurysms assessed by99mTc-MIBI SPECT and18F-FDG PET
T2 - A comparative study of medical and surgical treatment
AU - Zhang, Xiaoli
AU - Liu, Xiu Jie
AU - Hu, Shengshou
AU - Schindler, Thomas H.
AU - Tian, Yueqing
AU - He, Zuo Xiang
AU - Gao, Runlin
AU - Wu, Qingyu
AU - Wei, Hongxing
AU - Sayre, James W.
AU - Schelbert, Heinrich R.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/8/1
Y1 - 2008/8/1
N2 - The prognostic value of myocardial viability assessment on left ventricular (LV) aneurysms remains undetermined. We aimed, first, to evaluate the long-term survival benefit of assessing the viability of the aneurysmal myocardium in patients with ischemic cardiomyopathy and, second, in the revascularization subgroup, to compare the short-term effects on LV function and clinical symptoms in patients treated by revascularization alone or by revascularization plus aneurysmectomy. Methods: Seventy consecutive patients with an LV aneurysm who underwent 99mTc-sestamibi SPECT and 18F-FDG PET were followed up for a median of 6.8 y (range, 0.1-8.8 y). Only cardiac death during follow-up served as the endpoint. Patients were classified into 4 groups by aneurysmal viability and by treatment strategy (medical or surgical). Further, the effects of aneurysmectomy on LV function at 3 mo were evaluated by an analysis of revascularized patients grouped by aneurysmal viability and by aneurysmectomy. Results: Twenty-four patients were assigned to medical therapy, and 46 patients were assigned to surgery (18 revascularization alone and 28 revascularization plus aneurysmectomy). The annual cardiac mortality rate in patients with a viable aneurysm treated medically (n = 10) was significantly higher than that in patients with a viable aneurysm treated surgically (n = 23) (11.6% vs. 1.5%, χ2 = 12.87, P < 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n = 14) (χ2 = 4.13, P < 0.05) or surgically (n = 23) (χ2 = 10.46, P = 0.001). Multivariate analysis showed that the aneurysmal mismatch score (P = 0.003) and surgical therapy (P = 0.001) were independent predictors of cardiac death. Improvement of LV function and symptoms after revascularization (P < 0.05) was observed in patients with revascularization plus aneurysmectomy and in patients with a viable aneurysm and revascularization only. Conclusion: Viability in LV aneurysm in patients with ischemic cardiomyopathy was a negative independent predictor of survival. Compared with medical therapy, coronary revascularization was associated with improved long-term survival, symptoms, and LV function in patients with a viable aneurysm. These findings warrant further prospective investigations.
AB - The prognostic value of myocardial viability assessment on left ventricular (LV) aneurysms remains undetermined. We aimed, first, to evaluate the long-term survival benefit of assessing the viability of the aneurysmal myocardium in patients with ischemic cardiomyopathy and, second, in the revascularization subgroup, to compare the short-term effects on LV function and clinical symptoms in patients treated by revascularization alone or by revascularization plus aneurysmectomy. Methods: Seventy consecutive patients with an LV aneurysm who underwent 99mTc-sestamibi SPECT and 18F-FDG PET were followed up for a median of 6.8 y (range, 0.1-8.8 y). Only cardiac death during follow-up served as the endpoint. Patients were classified into 4 groups by aneurysmal viability and by treatment strategy (medical or surgical). Further, the effects of aneurysmectomy on LV function at 3 mo were evaluated by an analysis of revascularized patients grouped by aneurysmal viability and by aneurysmectomy. Results: Twenty-four patients were assigned to medical therapy, and 46 patients were assigned to surgery (18 revascularization alone and 28 revascularization plus aneurysmectomy). The annual cardiac mortality rate in patients with a viable aneurysm treated medically (n = 10) was significantly higher than that in patients with a viable aneurysm treated surgically (n = 23) (11.6% vs. 1.5%, χ2 = 12.87, P < 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n = 14) (χ2 = 4.13, P < 0.05) or surgically (n = 23) (χ2 = 10.46, P = 0.001). Multivariate analysis showed that the aneurysmal mismatch score (P = 0.003) and surgical therapy (P = 0.001) were independent predictors of cardiac death. Improvement of LV function and symptoms after revascularization (P < 0.05) was observed in patients with revascularization plus aneurysmectomy and in patients with a viable aneurysm and revascularization only. Conclusion: Viability in LV aneurysm in patients with ischemic cardiomyopathy was a negative independent predictor of survival. Compared with medical therapy, coronary revascularization was associated with improved long-term survival, symptoms, and LV function in patients with a viable aneurysm. These findings warrant further prospective investigations.
KW - Aneurysm
KW - Coronary disease
KW - Myocardial viability
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=48749127107&partnerID=8YFLogxK
U2 - 10.2967/jnumed.107.046730
DO - 10.2967/jnumed.107.046730
M3 - Article
C2 - 18632821
AN - SCOPUS:48749127107
SN - 0161-5505
VL - 49
SP - 1288
EP - 1298
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 8
ER -