Beanlands Rob S B, Nichol Graham, Huszti Ella, Humen Dennis, Racine Normand, Freeman Michael, Gulenchyn Karen Y, Garrard Linda, deKemp Robert, Guo Ann, Ruddy Terrence D, Benard Francois, Lamy André, Iwanochko Robert M
National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
J Am Coll Cardiol. 2007 Nov 13;50(20):2002-12. doi: 10.1016/j.jacc.2007.09.006. Epub 2007 Oct 10.
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.
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.
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.
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% CI 0.58 to 1.1; p = 0.15); for patients that adhered to PET recommendations for revascularization, revascularization work-up, or neither, HR = 0.62 (95% CI 0.42 to 0.93; p = 0.019); in those without recent angiography, for cardiac death, HR = 0.4 (95% CI 0.17 to 0.96; p = 0.035).
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.
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）辅助管理在严重心室功能障碍和疑似冠心病患者中的有效性。
这类患者可能从血运重建中获益，但围手术期发病率和死亡率较高。F-18-氟脱氧葡萄糖PET可以检测出血运重建后可能恢复的存活心肌。
纳入的患者为严重左心室（LV）功能障碍且疑似冠心病，正考虑进行血运重建、心力衰竭或移植检查，或PET被认为可能有用的患者。患者根据近期是否进行血管造影进行分层，然后随机分为FDG PET辅助管理组（n = 218）或标准治疗组（n = 212）。主要结局是1年内心脏死亡、心肌梗死或因心脏原因再次住院的复合事件。
1年时，经历复合事件的患者累积比例在PET组为30%，在标准治疗组为36%（相对风险0.82，95%置信区间[CI] 0.59至1.14；p = 0.16）。PET与标准治疗相比，复合结局的风险比（HR）为0.78（95%CI 0.58至1.1；p = 0.15）；对于遵循PET关于血运重建、血运重建检查或两者都不进行的建议的患者，HR = 0.62（95%CI 0.42至0.93；p = 0.019）；在近期未进行血管造影的患者中，对于心脏死亡，HR = 0.4（95%CI 0.17至0.96；p = 0.035）。
本研究未证明FDG PET辅助管理与标准治疗相比，能显著降低左心室功能障碍和疑似冠心病患者的心脏事件。在遵循PET建议的患者和近期未进行血管造影的患者中，观察到了显著益处。FDG PET的效用在这一亚组人群中以及在能够遵循建议时能得到最佳体现。
