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
| Autor: | Rob S. Beanlands, Benjamin J.W. Chow, Robert A. deKemp, Graham Nichol, Linda Garrard, Ann Guo, Arun Abraham, Ross A. Davies, Kathryn Williams, Haissam Haddad, Lloyd Duchesne, Jean N. DaSilva |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Canada medicine.medical_specialty medicine.medical_treatment Context (language use) Coronary Artery Disease Revascularization Coronary artery disease Ventricular Dysfunction Left Professional Competence Fluorodeoxyglucose F18 Internal medicine Myocardial Revascularization medicine Humans Radiology Nuclear Medicine and imaging Myocardial infarction Randomized Controlled Trials as Topic Heart Failure Patient Care Team Tissue Survival Ischemic cardiomyopathy Ejection fraction business.industry Hazard ratio Heart Middle Aged medicine.disease Survival Analysis Surgery Positron-Emission Tomography Heart failure Cardiology Female Radiopharmaceuticals business |
| Zdroj: | Journal of Nuclear Medicine. 51:567-574 |
| ISSN: | 2159-662X 0161-5505 |
| DOI: | 10.2967/jnumed.109.065938 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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