18F-FDG PET Imaging of Myocardial Viability in an Experienced Center with Access to 18F-FDG and Integration with Clinical Management Teams: The Ottawa-FIVE Substudy of the PARR 2 Trial

Journal of Nuclear Medicine

Linda Garrard¹  Rob S.B. Beanlands¹  Ann Guo¹  Robert A. deKemp¹  Ross A. Davies¹  Graham Nichol¹  Jean DaSilva¹  Kathryn A. Williams¹  for the PARR 2 Investigators¹  Haissam Haddad¹  Arun Abraham¹  Lloyd Duchesne¹  Benjamin Chow¹ 

关键词: cardiology (clinical);    PET;    fluorodeoxyglucose;    LV dysfunction;    viability;   

DOI  :  10.2967/jnumed.109.065938

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

18F-FDG PET may assist decision making in ischemic cardiomyopathy. The PET and Recovery Following Revascularization (PARR 2) trial demonstrated a trend toward beneficial outcomes with PET-assisted management. The substudy of PARR 2 that we call Ottawa-FIVE, described here, was a post hoc analysis to determine the benefit of PET in a center with experience, ready access to 18F-FDG, and integration with clinical teams. Methods: Included were patients with left ventricular dysfunction and suspected coronary artery disease being considered for revascularization. The patients had been randomized in PARR 2 to PET-assisted management (group 1) or standard care (group 2) and had been enrolled in Ottawa after August 1, 2002 (the date that on-site 18F-FDG was initiated) (n = 111). The primary outcome was the composite endpoint of cardiac death, myocardial infarction, or cardiac rehospitalization within 1 y. Data were compared with the rest of PARR 2 (PET-assisted management [group 3] or standard care [group 4]). Results: In the Ottawa-FIVE subgroup of PARR 2, the cumulative proportion of patients experiencing the composite event was 19% (group 1), versus 41% (group 2). Multivariable Cox proportional hazards regression showed a benefit for the PET-assisted strategy (hazard ratio, 0.34; 95% confidence interval, 0.16–0.72; P = 0.005). Compared with other patients in PARR 2, Ottawa-FIVE patients had a lower ejection fraction (25% ± 7% vs. 27% ± 8%, P = 0.04), were more often female (24% vs. 13%, P = 0.006), tended to be older (64 ± 10 y vs. 62 ± 10 y, P = 0.07), and had less previous coronary artery bypass grafting (13% vs. 21%, P = 0.07). For patients in the rest of PARR 2, there was no significant difference in events between groups 3 and 4. The observed effect of 18F-FDG PET–assisted management in the 4 groups in the context of adjusted survival curves demonstrated a significant interaction (P = 0.016). Comparisons of the 2 arms in Ottawa-FIVE to the 2 arms in the rest of PARR 2 demonstrated a trend toward significance (standard care, P = 0.145; PET-assisted management, P = 0.057). Conclusion: In this post hoc group analysis, a significant reduction in cardiac events was observed in patients with 18F-FDG PET–assisted management, compared with patients who received standard care. The results suggest that outcome may be benefited using 18F-FDG PET in an experienced center with ready access to 18F-FDG and integration with imaging, heart failure, and revascularization teams.

【 授权许可】

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