Beanlands R S, Hendry P J, Masters R G, deKemp R A, Woodend K, Ruddy T D
Cardiac PET Centre, University of Ottawa Heart Institute, Ontario, Canada.
Circulation. 1998 Nov 10;98(19 Suppl):II51-6.
The identification of high-risk patients who require early revascularization has become increasingly important with the present emphasis on reducing health care resources. This is particularly relevant to health care systems with prolonged waiting times for interventions. Myocardial viability imaging with the use of fluorine 18-fluorodeoxyglucose (FDG) PET may help to identify high-risk patients with severe left ventricular dysfunction. The aim of this study was to evaluate the consequences of prolonged waiting time on cardiac outcomes in patients with left ventricular dysfunction directed to revascularization based on FDG PET imaging.
Forty-six patients with coronary disease and an ejection fraction of < or = 35% were considered candidates for revascularization based on FDG PET viability imaging. Thirty-five of 46 patients were subsequently accepted for revascularization. Patients were divided into 2 groups based on the median waiting time after PET: an early group (< 35 days; n = 18) and a late group (> or = 35 days; n = 17). Preoperative mortality rates were significantly increased in the late group (4 of 17 [24%] versus 0 of 18 in the early group; P < 0.05). In postoperative follow-up (17 +/- 7 months), cardiac events occurred in 2 of 18 (11%) and 1 of 13 (7.8%) patients in the early and late groups, respectively. Left ventricular ejection fraction increased after early revascularization (24 +/- 7% to 29 +/- 8%, P < 0.001, baseline versus 3 months) but not in the late group (27 +/- 5% to 28 +/- 6%, P = NS).
Preoperative FDG PET can be used to identify a high-risk group of patients who may benefit from early revascularization. A long waiting time for revascularization is associated with a high mortality rate and suggests that early revascularization is desirable after the identification of hibernating viable myocardium.
随着当前对减少医疗资源的重视，识别需要早期血运重建的高危患者变得越来越重要。这对于干预等待时间较长的医疗系统尤为重要。使用氟18-氟脱氧葡萄糖（FDG）PET进行心肌存活显像可能有助于识别严重左心室功能障碍的高危患者。本研究的目的是评估基于FDG PET显像进行血运重建的左心室功能障碍患者，延长等待时间对心脏结局的影响。
46例冠心病且射血分数≤35%的患者基于FDG PET存活显像被视为血运重建的候选者。46例患者中有35例随后接受了血运重建。根据PET检查后的中位等待时间将患者分为两组：早期组（<35天；n = 18）和晚期组（≥35天；n = 17）。晚期组术前死亡率显著升高（17例中有4例[24%]，而早期组18例中为0例；P<0.05）。在术后随访（17±7个月）中，早期组和晚期组分别有18例中的2例（11%）和13例中的1例（7.8%）发生心脏事件。早期血运重建后左心室射血分数增加（从24±7%增至29±8%，P<0.001，基线对比3个月），但晚期组未增加（从27±5%增至28±6%，P=无显著性差异）。
术前FDG PET可用于识别可能从早期血运重建中获益的高危患者群体。血运重建的长时间等待与高死亡率相关，提示在识别出冬眠存活心肌后早期血运重建是可取的。
