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

被引:19
|
作者
Zhang, Xiaoli [1 ,2 ,3 ,4 ]
Liu, Xiu-jie [1 ,2 ,3 ]
Hu, Shengshou [2 ,3 ,5 ]
Schindler, Thomas H. [4 ]
Tian, Yueqing [1 ,2 ,3 ]
He, Zuo-xiang [1 ,2 ,3 ]
Gao, Runlin [2 ,3 ,6 ]
Wu, Qingyu [2 ,3 ,5 ]
Wei, Hongxing [1 ,2 ,3 ]
Sayre, James W. [4 ]
Schelbert, Heinrich R. [4 ]
机构
[1] Cardiovasc Inst, Dept Nucl Med, Beijing 100037, Peoples R China
[2] Fu Wai Hosp, Chinese Acad Med Sci, Beijing, Peoples R China
[3] Peking Union Med Coll, Beijing 100021, Peoples R China
[4] Univ Calif Los Angeles, David Geffen Sch Med, Dept Mol & Med Pharmacol, Los Angeles, CA 90095 USA
[5] Cardiovasc Inst, Dept Cardiovasc Surg, Beijing, Peoples R China
[6] Cardiovasc Inst, Dept Cardiol, Beijing, Peoples R China
关键词
coronary disease; aneurysm; myocardial viability; survival;
D O I
10.2967/jnumed.107.046730
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
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 Tc-99m-sestamibi SPECT and F-18-FDG PET were followed up fora 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%, chi(2) = 12.87, P < 0.0001) and was also significant higher than that in patients with a nonviable aneurysm treated medically (n = 14) (chi(2) = 4.13, P < 0.05) or surgically (n = 23) (chi(2) = 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
引用
收藏
页码:1288 / 1298
页数:11
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