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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1999 June;40(3):363-72

lingua: Inglese

Assessment of ­CABG-relat­ed ­risk in ­patients with CAD and LVD. Contribution of PET ­with [18F]FDG to the assessment of myocardial viability

Landoni C., Licignani G., Paolini G. *, Zuccari M. *, Galli L. **, Di Credico G. *, Rossetti C. *, Pelenghi S. *, Gilardi M. C., Fazio F., Grossi A. *

From the INB-CNR, Department of Nuclear Medicine
* Institute of Cardiovascular and Respiratory Diseases
** Epidemiology and Medical Statistics Unit University of Milan, Italy Scientific Institute H S. Raffaele Milan, Italy


Background. Previous stud­ies ­have dem­on­strat­ed ­that hiber­nat­ing myo­car­di­um can be ­assessed by [18F]flu­o­rod­e­ox­y­glu­cose ([18F]FDG) and posi­tron emis­sion tomog­ra­phy (PET). This ­study eval­u­at­ed the use of [18F]FDG-PET for ­CABG relat­ed ­risk assess­ment in ­patients ­with cor­o­nary ­artery dis­ease (CAD) and ­left ven­tri­cle dys­func­tion (LVD).
Methods. We ret­ro­spec­tive­ly eval­u­at­ed 241 ­to patients can­di­date ­CABG pre­sent­ing ­with ­signs and symp­toms of con­ges­tive ­heart fail­ure (CHF) pre­vail­ing ­over ischem­ic ­signs. Of the 241 ­patients, 153 had under­gone [18F]FDG-PET as ­well as con­ven­tion­al assess­ment: 110 out of 153 (group A) ­were oper­at­ed ­because of PET evi­dence of hiber­na­tion. Of the 241 ­patients, 88 had not under­gone [18F]FDG-PET: 86 out of 88 (group B) ­were oper­at­ed on. The out­come of sur­gi­cal ­patients was eval­u­at­ed by con­sid­er­ing all ­major per­i­op­er­a­tive com­pli­ca­tions includ­ing the use of mechan­i­cal and phar­mac­o­log­i­cal sup­port and in-hos­pi­tal mor­tal­ity. After hos­pi­tal dis­charge, ­each ­patient was exam­ined at 1, 4 and eve­ry 6 ­months there­af­ter.
Results. Perioperative use of mechan­i­cal sup­ports and inotrop­ic ­drugs, was sig­nif­i­cant­ly low­er for the PET select­ed ­group (A) ­than for the non PET select­ed ­group (B). Mortality with­in 30 ­days of sur­gery was 0.9% in ­group A and 19.8% in ­group B. The ­only pre­dic­tors of per­i­op­er­a­tive out­come ­were the pres­ence of hiber­nat­ing tis­sue and the ejec­tion frac­tion.
Conclusions. [18F]FDG-PET ­prior to ­CABG can be cru­cial for the assess­ment of per­i­op­er­a­tive ­risk in ­patients ­with CAD.

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