Document Detail

Myocardial scar and insulin resistance predict cardiovascular events in severe ischaemic myocardial dysfunction: a perfusion-metabolism positron emission tomography study.
MedLine Citation:
PMID:  18391729     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Clinical outcome can be predicted by metabolism-perfusion positron emission tomography (PET) in patients with severe ischaemic left ventricular dysfunction. This study determined whether the amount of viable or non-viable myocardium detected with a PET scan or clinical-functional parameters might predict cardiovascular events. METHODS: All patients had previous myocardial infarction (>6 months previously) and left ventricular ejection fraction (LVEF) <40%. Metabolism-perfusion PET, echocardiogram and coronary angiography were provided. All subjects underwent short euglycaemic-hyperinsulinaemic clamp before the metabolism study. The dysfunctioning segment was defined as hibernating myocardium when metabolism was normal-moderately reduced with impaired perfusion (mismatch flow-metabolism). Cardiac death, hospital admission for myocardial infarction or heart failure were considered cardiovascular events. RESULTS: Ninety-three patients (71 males, aged 64.2 years) were studied. The LVEF was 30.2+/-7.7%; 48 (51.6%) suffered an anterior myocardial infarction. Fifty-three (54.1%) subjects were treated with coronary revascularization; all had optimal medical therapy. Cardiovascular events occurred in 20/93 patients at 1-year follow-up (event group). Age (P=0.7), diabetes mellitus (P=0.6) and rate of coronary revascularization (P=0.3) were not different in the two groups. Patients who experienced cardiovascular events had larger non-viable myocardium (5.8+/-2.7 vs. 4.1+/-2.6, P=0.01), lower metabolic rate glucose (1.3+/-0.6 vs. 1.7+/-0.7 ml . kg . min, P=0.04) but similar hibernating myocardium (1.6+/-1.6 vs. 1.7+/-2, P=0.8) and baseline LVEF (28.1+/-4.8 vs. 30.7+/-8.3%, P=0.08). Having more then five non-viable segments and a metabolic rate for glucose of <0.9 mg . kg . min predicted a worse prognosis (P=0.04, log rank, 3.89; and P=0.004, log rank, 8.1, respectively). CONCLUSION: Non-viable myocardium revealed with PET predicts mid-term clinical prognosis. Insulin resistance seems to influence the outcome.
Mauro Feola; Alberto Biggi; Stéphane Chauvie; Antonello Vado; Giovanni Leonardi; Fabrizio Rolfo; Flavio Ribichini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Nuclear medicine communications     Volume:  29     ISSN:  0143-3636     ISO Abbreviation:  Nucl Med Commun     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8201017     Medline TA:  Nucl Med Commun     Country:  England    
Other Details:
Languages:  eng     Pagination:  448-54     Citation Subset:  IM    
Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle, Via Coppino 26, Cuneo, Italy.
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MeSH Terms
Insulin Resistance*
Italy / epidemiology
Middle Aged
Myocardial Ischemia / epidemiology*,  radionuclide imaging*
Myocardial Stunning / epidemiology*,  radionuclide imaging*
Risk Assessment / methods*
Risk Factors
Ventricular Dysfunction, Left / epidemiology*,  radionuclide imaging*

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