F-18-fluorodeoxyglucose positron emission tomography imaging-assisted management 2002 of patients with severe left ventricular dysfunction and suspected coronary disease: A randomized, controlled trial (PARR-2)
F-18-fluorodeoxyglucose positron emission tomography imaging-assisted management 2002 of patients with severe left ventricular dysfunction and suspected coronary disease: A randomized, controlled trial (PARR-2)
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DOI：
10.1016/j.jacc.2007.09.006
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发表时间：
2007-11-13
影响因子：
24
通讯作者：
Iwanochko, Robert M.
中科院分区：
文献类型：
--
作者：
Beanlands, Rob S. B.;Nichol, Graham;Iwanochko, Robert M.
我们进行了一项随机试验，以评估f -18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）辅助治疗严重心室功能障碍和疑似冠心病患者的有效性。背景：此类患者可从血运重建术中获益，但围手术期发病率和死亡率较高。f -18-氟脱氧葡萄糖PET可检出血运重建后可能恢复的活心肌。方法纳入严重左室（LV）功能障碍和疑似冠状动脉疾病的患者，考虑进行血运重建、心力衰竭或移植检查，或PET被认为可能有用。根据是否近期血管造影对患者进行分层，然后随机分为FDG PET辅助治疗组（n = 218）和标准治疗组（n = 212）。主要结局是1年内心源性死亡、心肌梗死或因心脏原因反复住院的综合结果。结果在1年时，经历复合事件的患者累积比例为30% （PET组）和36%（标准组）（相对危险度0.82,95%可信区间[CI] 0.59 ~ 1.14; p = 0.16）。PET与标准护理的复合结局的危险比（HR）为0.78 (95% Cl = 0.58至：1.1;p = 015)；对于坚持PET建议进行血运重建、血运重建检查或两者均不进行的患者，HR = 0.62 (95% Cl = 0.42 ~ 0.93; p = 0.019)；在没有近期血管造影的患者中，心源性死亡的HR = 0.4 （95% Cl = 0.17 ~ 0.96; p = 0.035）。结论：与标准治疗相比，本研究并未证明FDG pet辅助治疗能显著降低左室功能障碍和疑似冠状动脉疾病患者的心脏事件。在那些坚持PET推荐和最近没有血管造影的患者中，观察到显着的益处。FDG PET的效用在这一亚群中得到最好的实现，并且在遵守建议的情况下可以实现。[J]中华医学会心脏科杂志2007；50:2002- 12)(c) 2007。
Objectives We conducted a randomized trial to assess the effectiveness of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-assisted management in patients with severe ventricular dysfunction and suspected coronary disease.Background Such patients may benefit from revascularization, but have significant perioperative morbidity and mortality. F-18-fluorodeoxyglucose PET can detect viable myocardium that might recover after revascularization.Methods Included were patients with severe left ventricular (LV) dysfunction and suspected coronary disease being considered for revascularization, heart failure, or transplantation work-ups or in whom PET was considered potentially useful. Patients were stratified according to recent angiography or not, then randomized to management assisted by FDG PET (n = 218) or standard care (n = 212). The primary outcome was the composite of cardiac death, myocardial infarction, or recurrent hospital stay for cardiac cause, within 1 year.Results At 1 year, the cumulative proportion of patients who had experienced the composite event was 30% (PET arm) versus 36% (standard arm) (relative risk 0.82, 95% confidence interval [CI] 0.59 to 1.14; p = 0.16). The hazard ratio (HR) for the composite outcome, PET versus standard care, was 0.78 (95% Cl 0.58 to:1.1; p = 015); for patients that adhered to PET recommendations for revascularization, revascularization work-up, or neither, HR = 0.62 (95% Cl 0.42 to 0.93; p = 0.019); in those without recent angiography, for cardiac death, HR = 0.4 (95% Cl 0.17 to 0.96; p = 0.035).Conclusions This study did not demonstrate a significant reduction in cardiac events in patients with LV dysfunction and suspected coronary disease for FDG PET-assisted management versus standard care. In those who adhered to PET recommendations and in patients without recent angiography, significant benefits were observed. The utility of FDG PET is best realized in this subpopulation and when adherence to recommendations can be achieved. (J Am Coll Cardiol 2007;50:2002-:12) (c) 2007 by the American College of Cardiology Foundation.