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European Heart Journal 2001 22(18):1691-1701; doi:10.1053/euhj.2000.2585
Copyright © 2001 by the European Society of Cardiology.
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Positron emission tomography using18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp: optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. Results from the European Community Concerted Action Multicenter study on use of18F-fluoro-deoxyglucose Positron Emission Tomography for the Detection of Myocardial Viability

B.L Gerbera, F.F Ordoubadib, W Wijnsa, J.-L.J Vanoverscheldea, M.J Knuutic, M Janierd, P Melone, P.K Blanksmaf, A Bola, J.J Baxa, J.A Melinb and P.G Camicib,f1

b MRC Clinical Sciences Centre, Imperial College School of Medicine, Hammersmith Hospital, London, U.K.
a Division of Cardiology and Positron Emission Tomography, University of Louvain, Brussels, Belgium
c Turku PET Center, Turku University Central Hospital, Finland
d CERMEP, University of Lyon, France
e Cyclotron Research Center, University of Liege, Belgium
f ThoraxCenter and PET Center, University of Groningen, The Netherlands

revised December 19, 2000; accepted December 20, 2000

Abstract

Aims To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease.

Methods and Results One hundred and seventy-eight patients (157 male, 58±10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39±14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using18F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2–6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%).

Conclusions In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.

Key Words: Coronary artery disease, myocardial viability, euglycaemic hyperinsulinaemic glucose clamp, positron emission tomography,8F-fluoro-2-deoxyglucose

f1 Correspondence: Paolo Camici, MD, MRC Cyclotron Unit, Hammersmith Hospital, Du Cane Road, London W12 0NN, U.K. email:paolo.camici@csc.mrc.ac.uk

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