PET Predicts Outcomes in Diabetic Patients

Results of positron emission tomography (PET) scans predict outcomes after revascularization in patients with diabetes and ischemic left ventricular dysfunction.

Dr. Stephen Sawada from Indiana University School of Medicine, said that, "Patients with severely depressed ejection fractions (ejection fraction < 30%) were most likely to benefit from the information provided by the scan." "If they had evidence of viable myocardium they had substantially improved long-term survival if they were revascularized."

Dr. Sawada and colleagues investigated the value of perfusion-metabolism imaging for prediction of long-term prognosis in 61 patients who had diabetes and left ventricular dysfunction.

Among patients who underwent revascularization, there were no significant clinical or imaging predictors of cardiac death, the authors report. Among patients who received medical therapy, though, perfusion-metabolism mismatch of at least 3% of the left ventricle was the sole independent predictor of cardiac death.

After follow-up extending as late as 8 years, the results indicate, the proportions of deaths among patients with mismatch were 83% in the medically treated group and 47% in the group treated with revascularization.

In patients with significant mismatch, the difference in cardiac death rates was most profound among patients whose ejection fractions were below 30%, the researchers note. Eight-year survival was 0% in patients who received medical therapy and 55% in those who underwent revascularization.

Four-year survival among patients with large perfusion defects was improved by revascularization, the report indicates, but the difference did not persist at 8 years.

"It is certainly true that medical therapy with ACE inhibitors and beta-blockers and statins have effectively prolonged survival in patients with advanced left ventricular dysfunction, but the magnitude of the effect is more in the 15 to 30% range (in terms of improvement in survival)," Dr. Sawada said. "Ours and many other studies have shown that the magnitude of improvement in survival with revascularization is much larger than what can be achieved with medical therapy, as long as the mortality and morbidity from revascularization is not too high."

"Doctors who see these patients should consider viability testing or referral of these patients to specialized centers that do these studies and have the expertise and willingness to consider high risk revascularization," Dr. Sawada concluded.
Am J Cardiol 2005;96:2-8.

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