Utility of positron emission tomography in predicting improved left ventricular ejection fraction after coronary artery bypass grafting among patients with ischemic cardiomyopathy.
Utility of positron emission tomography in predicting improved left ventricular ejection fraction after coronary artery bypass grafting among patients with ischemic cardiomyopathy.
复制标题
正电子发射断层扫描在预测缺血性心肌病患者冠状动脉旁路移植术后左心室射血分数改善中的应用。
作者：
McFalls,EO;Baldwin,D;Kuskowski,M;Liow,J;Chesler,E;Ward,HB
本研究的目的是确定术前估计局部心肌摄取18-F-氟脱氧葡萄糖（FDG）是否可以预测缺血性心肌病患者接受冠状动脉旁路移植术（CABG）后射血分数的改善。20例连续患者[左心室射血分数（LVEF）≤ 27%]接受术前正电子发射断层扫描（PET），以测量局部心肌FDG摄取，并被视为CABG的候选人。所有人都有技术上足够的血管和显著的生存能力。所有患者的冠状动脉左前降支（LAD）均严重病变。由于前壁对整体心室性能的重要性，FDG摄取在这些区域进行半定量，并与术后LVEF相关。17例患者接受CABG，恢复顺利。术后2周LVEF从22±4增加到26±7%（p< 0.05），7例患者（第1组）变化≥ 5%，10例患者（第2组）变化< 5%。没有术前或围手术期临床变量可以预测心室功能改善的患者。第1组前壁FDG摄取的相对量高于第2组（93±9 vs. 81±13%; p< 0.05），并且与CABG后LVEF的变化相关（r= 0.50; p< 0.05）。88%的LAD区域FDG摄取对旁路术后LVEF改善的阳性预测准确率为67%，阴性预测准确率为88%。LVEF的后期随访估计值（中位数为10个月）显示，早期功能变化持续存在。总之，在严重冠状动脉疾病和LVEF降低的患者中，心室功能可能改善血管重建后早期。PET估计前壁相对FDG摄取有助于预测那些可能具有最大LVEF增量的个体。
The objective of this study was to determine whether preoperative estimates of regional myocardial uptake of 18-F-fluorodeoxyglucose (FDG) could predict postoperative improvement in ejection fraction in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy. 20 consecutive patients [left ventricular ejection fraction (LVEF)≤ 27%] were referred for preoperative positron emission tomography (PET) to measure regional myocardial FDG uptake and were deemed candidates for CABG. All individuals had technically adequate vessels and significant viability. The left anterior descending (LAD) coronary artery was severely diseased in all patients. Because of the importance of the anterior wall to overall ventricular performance, FDG uptake was semiquantitated in those regions and related to postoperative LVEF. 17 patients underwent CABG with an uneventful recovery. LVEF increased from 22±4 to 26±7% 2 weeks postsurgery (p< 0.05), with≥ 5% change noted in 7 patients (group 1) and< 5% noted in 10 patients (group 2). No preoperative or perioperative clinical variable could predict those with improved ventricular function. The relative amount of FDG uptake in the anterior wall was higher in group 1 compared with group 2 (93±9 vs. 81±13%; p< 0.05) and correlated with the change in LVEF post-CABG (r= 0.50; p< 0.05).> 88% of FDG uptake in the LAD region had a positive predictive accuracy of 67% and negative predictive accuracy of 88% for improved LVEF postbypass. Late follow-up estimates of LVEF (median of 10 months) showed that early changes in function were sustained. In summary, among patients with severe coronary artery disease and depressed LVEF, ventricular function may improve early postrevascularization. PET estimates of relative FDG uptake in the anterior wall help predict those individuals who are likely to have the greatest increment in LVEF.