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Long-term survival of patients with viable and nonviable aneurysms assessed by 99mTc-MIBI SPECT and 18F-FDG PET: a comparative study of medical and surgical treatment

Authors
Zhang, Xiaoli
Liu, Xiu-jie
Hu, Shengshou
Tian, Yueqing
He, Zuo-xiang
Gao, Runlin
Wu, Qingyu
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Published in Journal of Nuclear Medicine. 2008, vol. 49, no. 8, p. 1288-98
Abstract The prognostic value of myocardial viability assessment on left ventricular (LV) aneurysms remains undetermined. We aimed, first, to evaluate the long-term survival benefit of assessing the viability of the aneurysmal myocardium in patients with ischemic cardiomyopathy and, second, in the revascularization subgroup, to compare the short-term effects on LV function and clinical symptoms in patients treated by revascularization alone or by revascularization plus aneurysmectomy. METHODS: Seventy consecutive patients with an LV aneurysm who underwent 99mTc-sestamibi SPECT and 18F-FDG PET were followed up for a median of 6.8 y (range, 0.1-8.8 y). Only cardiac death during follow-up served as the endpoint. Patients were classified into 4 groups by aneurysmal viability and by treatment strategy (medical or surgical). Further, the effects of aneurysmectomy on LV function at 3 mo were evaluated by an analysis of revascularized patients grouped by aneurysmal viability and by aneurysmectomy. RESULTS: Twenty-four patients were assigned to medical therapy, and 46 patients were assigned to surgery (18 revascularization alone and 28 revascularization plus aneurysmectomy). The annual cardiac mortality rate in patients with a viable aneurysm treated medically (n = 10) was significantly higher than that in patients with a viable aneurysm treated surgically (n = 23) (11.6% vs. 1.5%, chi2 = 12.87, P < 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n = 14) (chi2 = 4.13, P < 0.05) or surgically (n = 23) (chi2 = 10.46, P = 0.001). Multivariate analysis showed that the aneurysmal mismatch score (P = 0.003) and surgical therapy (P = 0.001) were independent predictors of cardiac death. Improvement of LV function and symptoms after revascularization (P < 0.05) was observed in patients with revascularization plus aneurysmectomy and in patients with a viable aneurysm and revascularization only. CONCLUSION: Viability in LV aneurysm in patients with ischemic cardiomyopathy was a negative independent predictor of survival. Compared with medical therapy, coronary revascularization was associated with improved long-term survival, symptoms, and LV function in patients with a viable aneurysm. These findings warrant further prospective investigations.
Keywords AgedCardiomyopathies/mortality/radionuclide imaging/surgeryFemaleFluorodeoxyglucose F18/diagnostic useHeart Aneurysm/mortality/radionuclide imaging/surgeryHumansKaplan-Meiers EstimateMaleMiddle AgedMyocardial RevascularizationPositron-Emission TomographyRadiopharmaceuticals/diagnostic useRetrospective StudiesTechnetium Tc 99m Sestamibi/diagnostic useTomography, Emission-Computed, Single-PhotonVentricular Function, Left
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PMID: 18632821
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Research group Groupe Schindler Thomas (cardiologie) (890)
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ZHANG, Xiaoli et al. Long-term survival of patients with viable and nonviable aneurysms assessed by 99mTc-MIBI SPECT and 18F-FDG PET: a comparative study of medical and surgical treatment. In: Journal of Nuclear Medicine, 2008, vol. 49, n° 8, p. 1288-98. https://archive-ouverte.unige.ch/unige:3392

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Deposited on : 2009-09-28

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