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Lars Poulsen Tolbod

Reverse Mismatch Pattern in Cardiac 18F-FDG Viability PET/CT Is Not Associated With Poor Outcome of Revascularization: A Retrospective Outcome Study of 91 Patients With Heart Failure

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Reverse Mismatch Pattern in Cardiac 18F-FDG Viability PET/CT Is Not Associated With Poor Outcome of Revascularization: A Retrospective Outcome Study of 91 Patients With Heart Failure. / Hansen, Allan Kjeldsen; Jensen, Michael Gejl; Bouchelouche, Kirsten; Tolbod, Lars Poulsen; Gormsen, Lars Christian.

In: Clinical Nuclear Medicine, Vol. 41, No. 10, 2016, p. e428-35.

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@article{33b3450d3d5e45b8a860fa42175a0418,
title = "Reverse Mismatch Pattern in Cardiac 18F-FDG Viability PET/CT Is Not Associated With Poor Outcome of Revascularization: A Retrospective Outcome Study of 91 Patients With Heart Failure",
abstract = "PURPOSE: Revascularization strategies in patients with ischemic heart failure (HF) should be based on evidence of reversible perfusion defects and myocardial viability. Myocardial viability assessment is preferably based on dual isotope PET using perfusion and metabolism tracers. However, in a nonnegligible subset of HF patients, reverse mismatch (RM) pattern (reduced glucose uptake relative to perfusion) of unknown origin is observed. We aimed to investigate determinants of RM and the impact of RM on the subsequent improvement in left ventricular function by revascularization.PATIENTS AND METHODS: Ninety-one patients (12 women, 25 with diabetes) with HF undergoing Rb perfusion PET and hyperinsulinemic-euglycemic clamp F-FDG viability PET were retrospectively reviewed.RESULTS: Follow-up time was 12 to 33 months. In 30 of 91 patients, hypometabolic myocardium exceeded the percentage of hypoperfused myocardium; however, only in 12 of 91 patients was the RM considered significant (percentage RM in the left ventricle, 42.5 ± 12.9 [reverse patients] vs 14.1 ± 8.6 [scar and hibernation patients]; P < 0.001). Diabetes status per se did not predict RM, but a significant inverse correlation between insulin sensitivity and RM was observed. The frequency of hospitalization, cardiac death, and myocardial infarctions were not significantly higher in RM patients. Reverse mismatch patients benefited from revascularization to the same extent as patient with normal metabolic patterns.CONCLUSIONS: Reverse mismatch is common among HF patients (~15%) and is inversely correlated to insulin sensitivity. It is not, however, associated with increased cardiac morbidity and mortality and does not predict a worse outcome after revascularization.",
keywords = "Aged, Female, Fluorodeoxyglucose F18, Heart Failure, Humans, Male, Myocardial Revascularization, Positron Emission Tomography Computed Tomography, Retrospective Studies, Treatment Outcome, Ventricular Function, Left, Journal Article",
author = "Hansen, {Allan Kjeldsen} and Jensen, {Michael Gejl} and Kirsten Bouchelouche and Tolbod, {Lars Poulsen} and Gormsen, {Lars Christian}",
year = "2016",
doi = "10.1097/RLU.0000000000001312",
language = "English",
volume = "41",
pages = "e428--35",
journal = "Clinical Nuclear Medicine",
issn = "0363-9762",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "10",

}

RIS

TY - JOUR

T1 - Reverse Mismatch Pattern in Cardiac 18F-FDG Viability PET/CT Is Not Associated With Poor Outcome of Revascularization: A Retrospective Outcome Study of 91 Patients With Heart Failure

AU - Hansen, Allan Kjeldsen

AU - Jensen, Michael Gejl

AU - Bouchelouche, Kirsten

AU - Tolbod, Lars Poulsen

AU - Gormsen, Lars Christian

PY - 2016

Y1 - 2016

N2 - PURPOSE: Revascularization strategies in patients with ischemic heart failure (HF) should be based on evidence of reversible perfusion defects and myocardial viability. Myocardial viability assessment is preferably based on dual isotope PET using perfusion and metabolism tracers. However, in a nonnegligible subset of HF patients, reverse mismatch (RM) pattern (reduced glucose uptake relative to perfusion) of unknown origin is observed. We aimed to investigate determinants of RM and the impact of RM on the subsequent improvement in left ventricular function by revascularization.PATIENTS AND METHODS: Ninety-one patients (12 women, 25 with diabetes) with HF undergoing Rb perfusion PET and hyperinsulinemic-euglycemic clamp F-FDG viability PET were retrospectively reviewed.RESULTS: Follow-up time was 12 to 33 months. In 30 of 91 patients, hypometabolic myocardium exceeded the percentage of hypoperfused myocardium; however, only in 12 of 91 patients was the RM considered significant (percentage RM in the left ventricle, 42.5 ± 12.9 [reverse patients] vs 14.1 ± 8.6 [scar and hibernation patients]; P < 0.001). Diabetes status per se did not predict RM, but a significant inverse correlation between insulin sensitivity and RM was observed. The frequency of hospitalization, cardiac death, and myocardial infarctions were not significantly higher in RM patients. Reverse mismatch patients benefited from revascularization to the same extent as patient with normal metabolic patterns.CONCLUSIONS: Reverse mismatch is common among HF patients (~15%) and is inversely correlated to insulin sensitivity. It is not, however, associated with increased cardiac morbidity and mortality and does not predict a worse outcome after revascularization.

AB - PURPOSE: Revascularization strategies in patients with ischemic heart failure (HF) should be based on evidence of reversible perfusion defects and myocardial viability. Myocardial viability assessment is preferably based on dual isotope PET using perfusion and metabolism tracers. However, in a nonnegligible subset of HF patients, reverse mismatch (RM) pattern (reduced glucose uptake relative to perfusion) of unknown origin is observed. We aimed to investigate determinants of RM and the impact of RM on the subsequent improvement in left ventricular function by revascularization.PATIENTS AND METHODS: Ninety-one patients (12 women, 25 with diabetes) with HF undergoing Rb perfusion PET and hyperinsulinemic-euglycemic clamp F-FDG viability PET were retrospectively reviewed.RESULTS: Follow-up time was 12 to 33 months. In 30 of 91 patients, hypometabolic myocardium exceeded the percentage of hypoperfused myocardium; however, only in 12 of 91 patients was the RM considered significant (percentage RM in the left ventricle, 42.5 ± 12.9 [reverse patients] vs 14.1 ± 8.6 [scar and hibernation patients]; P < 0.001). Diabetes status per se did not predict RM, but a significant inverse correlation between insulin sensitivity and RM was observed. The frequency of hospitalization, cardiac death, and myocardial infarctions were not significantly higher in RM patients. Reverse mismatch patients benefited from revascularization to the same extent as patient with normal metabolic patterns.CONCLUSIONS: Reverse mismatch is common among HF patients (~15%) and is inversely correlated to insulin sensitivity. It is not, however, associated with increased cardiac morbidity and mortality and does not predict a worse outcome after revascularization.

KW - Aged

KW - Female

KW - Fluorodeoxyglucose F18

KW - Heart Failure

KW - Humans

KW - Male

KW - Myocardial Revascularization

KW - Positron Emission Tomography Computed Tomography

KW - Retrospective Studies

KW - Treatment Outcome

KW - Ventricular Function, Left

KW - Journal Article

U2 - 10.1097/RLU.0000000000001312

DO - 10.1097/RLU.0000000000001312

M3 - Journal article

C2 - 27488429

VL - 41

SP - e428-35

JO - Clinical Nuclear Medicine

JF - Clinical Nuclear Medicine

SN - 0363-9762

IS - 10

ER -