RELATION OF REGIONAL FUNCTION, PERFUSION, AND METABOLISM IN PATIENTS WITH ADVANCED CORONARY-ARTERY DISEASE UNDERGOING SURGICAL REVASCULARIZATION
RELATION OF REGIONAL FUNCTION, PERFUSION, AND METABOLISM IN PATIENTS WITH ADVANCED CORONARY-ARTERY DISEASE UNDERGOING SURGICAL REVASCULARIZATION
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DOI：
10.1161/01.cir.90.5.2356
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发表时间：
1994-11-01
期刊：
影响因子：
37.8
通讯作者：
SCHWAIGER, M
中科院分区：
文献类型：
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作者：
VOMDAHL, J;EITZMAN, DT;SCHWAIGER, M
背景使用[F-18]氟脱氧葡萄糖（FDG）和正电子发射断层扫描（PET）进行心肌葡萄糖代谢成像已被提议用于识别晚期冠状动脉疾病患者的组织活力。本研究旨在评价血流和代谢显像对不同程度功能障碍的心肌节段血运重建后功能恢复的预测价值。（平均年龄59 ± 11岁），患有冠状动脉疾病和左心室功能受损（射血分数，34+/-10%）在外科冠状动脉血运重建术（每例患者3+/-1次移植）前使用FDG和[N-13]氨进行PET研究。组织的特征为正常、无活力（灌注和FDG摄取一致性降低）、无灌注和代谢不一致性的活力（灌注和代谢轻度降低）或缺血受损（灌注降低和FDG摄取维持不匹配）。在冠状动脉血运重建术之前和之后13+/-13周（中位间隔8周）通过连续放射性核素心室造影评估功能结局。术前受损的局部室壁运动在缺血受损（不匹配）的血管重建节段中显著改善，但在无存活心肌或无灌注和代谢不一致的存活心肌中没有改善。PET的功能恢复的阴性预测值为86%，而在血管重建区域的阳性预测值范围从48%到86%，取决于基线室壁运动abnormals.Conclusions的严重程度PET识别代谢活跃的组织，从血管重建中受益。虽然PET对恢复的阴性预测值很高，但存活但缺血受损组织的功能改善不如以前报道的频繁。PET的预测价值最高的左室节段严重功能障碍和不匹配或减少灌注，但保留代谢。PET、血管造影和功能数据的整合对于最佳选择晚期冠状动脉疾病和左心室功能受损的患者进行血运重建是必要的。
Background Imaging of myocardial glucose metabolism using [F-18]fluorodeoxyglucose (FDG) with positron emission tomography (PET) has been proposed for identification of tissue viability in patients with advanced coronary artery disease. This study was designed to evaluate the predictive value of flow and metabolic imaging for functional recovery after revascularization in myocardial segments of varying degrees of dysfunction.Methods and Results Thirty-seven patients (mean age, 59+/-11 years) with coronary artery disease and impaired left ventricular function (ejection fraction, 34+/-10%) were studied with PET using FDG and [N-13]ammonia before surgical coronary revascularization (3+/-1 grafts per patient). Tissue was scintigraphically characterized as normal, nonviable (concordant reduction of perfusion and FDG uptake), viable without discordance of perfusion and metabolism (mildly reduced perfusion and metabolism), or ischemically compromised (mismatch of reduced perfusion and maintained FDG uptake). Functional outcome was assessed by serial radionuclide ventriculography before and at 13+/-13 weeks (median interval of 8 weeks) after coronary revascularization. Preoperatively impaired regional wall motion improved significantly in ischemically compromised (mismatch) revascularized segments but not in nonviable myocardium or in viable myocardium without discordance of perfusion and metabolism. The negative predictive value of PET for functional recovery was 86%, whereas the positive predictive value in revascularized regions ranged from 48% to 86%, depending on severity of baseline wall motion abnormalities.Conclusions PET identifies metabolically active tissue, which benefits from revascularization. Although the negative predictive value of PET for recovery was high, functional improvement of viable but ischemically compromised tissue was less frequent than previously reported. The predictive value of PET was highest in left ventricular segments with severe dysfunction and a mismatch or reduced perfusion but preserved metabolism. Integration of PET, angiographic, and functional data is necessary for the optimal selection of patients with advanced coronary artery disease and impaired left ventricular function for revascularization.