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Ann Thorac Surg 1997;64:1701
© 1997 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Nuklearmedizinische Klinik und, Poliklinik der Technischen Universitat München, Klinikum rechts der Isar, Ismaniger Strasse 22, 8000 München 80, Germany

See also page 1694.

This article by Dr Flameng and associates provides additional evidence that metabolic imaging with positron emission tomography (PET) offers important clinical information for the selection of patients with advanced coronary artery disease for surgical revascularization. In contrast to several previous investigations, which concentrated on the predictive value of metabolic imaging for recovery of regional wall motion, Flameng and associates analyzed the impact of metabolic imaging on the prediction of recovery of global left ventricular function. About 60% of the studied patients had improved left ventricular function after revascularization. The relative increase was largest in patients with an ejection fraction less than 0.40. Recovery was correlated to the number of myocardial segments that displayed a "mismatch" PET pattern as a sign of jeopardized myocardium. These data and previous investigations strongly suggest that patients with severely reduced left ventricular function benefit most from PET viability studies. In addition, it has been shown that a "mismatch" PET pattern identifies patients with a high incidence of cardiovascular complications in patients without revascularization [1, 2]. There is overall agreement that metabolic evidence of viable, but jeopardized myocardium represents an established indication for revascularization. On the other hand, there is ongoing controversy about whether patients without evidence of PET "mismatch" but impaired left ventricular function should be revascularized or not. Large studies comparing medical and surgical therapy in patients with impaired left ventricular function indicated superiority of the surgical approach, independent of viability. One can speculate that the revascularization, in addition to its beneficial effect on left ventricular function, reduces repetitive, stress-induced ischemia and protects remote myocardium in case of recurrent myocardial infarctions. Prospective, randomized studies are required to define the benefit of viability studies on long-term outcome of patients with impaired left ventricular function undergoing revascularization.

References

1. Eitzmann D, Al-Aouar ZR, Kanter HL, et al. Prognostic significance of PET assessment of myocardial viability in patients with left ventricular dysfunction [Abstract]. J Am Coll Cardiol 1992;19:142A.
2. DiCarli MF, Davidson M, Little R, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994;73:527–33.[Medline]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schwaiger, M. Search for Related Content PubMed Articles by Schwaiger, M. Related Collections Related Article