Yoichi Inaba1, Jennifer A Chen, Steven R Bergmann. 1. Division of Cardiovascular Medicine, Oregon Health and Science University, UHN62, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. yoichiinaba@yahoo.com
Abstract
BACKGROUND: This meta-analysis was conducted to determine optimal cutoff values for the assessment of viability using various imaging techniques for which revascularization would offer a survival benefit in patients with ischemic cardiomyopathy (ICM). METHODS AND RESULTS: We searched five electronic databases to identify relevant studies through December 2008. Relative risks of cardiac death, both in patients with and without viability, were calculated in each study. In order to estimate the optimal threshold for the presence of viability, we assumed a linear relationship between the amount of viable myocardium and survival benefit of revascularization. Twenty-nine studies (4,167 patients) met the inclusion criteria. The optimal threshold for the presence of viability was estimated to be 25.8% (95% CI: 16.6-35.0%) by positron emission tomography using 18F-fluorodeoxyglucose-perfusion mismatch, 35.9% (95% CI: 31.6-40.3%) by stress echocardiography using contractile reserve or ischemic responses, and 38.7% (95% CI: 27.7-49.7%) by single photon emission computed tomography using thallium-201 or technetium-99m MIBI myocardial perfusion. CONCLUSIONS: The calculated amount of viable myocardium determined to lead to improved survival was different among imaging techniques. Thus, separate cutoff values for imaging modalities may be helpful in determining which patients with ICM benefit from revascularization.
BACKGROUND: This meta-analysis was conducted to determine optimal cutoff values for the assessment of viability using various imaging techniques for which revascularization would offer a survival benefit in patients with ischemic cardiomyopathy (ICM). METHODS AND RESULTS: We searched five electronic databases to identify relevant studies through December 2008. Relative risks of cardiac death, both in patients with and without viability, were calculated in each study. In order to estimate the optimal threshold for the presence of viability, we assumed a linear relationship between the amount of viable myocardium and survival benefit of revascularization. Twenty-nine studies (4,167 patients) met the inclusion criteria. The optimal threshold for the presence of viability was estimated to be 25.8% (95% CI: 16.6-35.0%) by positron emission tomography using 18F-fluorodeoxyglucose-perfusion mismatch, 35.9% (95% CI: 31.6-40.3%) by stress echocardiography using contractile reserve or ischemic responses, and 38.7% (95% CI: 27.7-49.7%) by single photon emission computed tomography using thallium-201 or technetium-99m MIBI myocardial perfusion. CONCLUSIONS: The calculated amount of viable myocardium determined to lead to improved survival was different among imaging techniques. Thus, separate cutoff values for imaging modalities may be helpful in determining which patients with ICM benefit from revascularization.
Authors: Lawrence Liao; Christopher H Cabell; James G Jollis; Eric J Velazquez; William T Smith; Kevin J Anstrom; Paul A Pappas; Thomas Ryan; Joseph A Kisslo; Carolyn K Landolfo Journal: Am J Cardiol Date: 2004-05-15 Impact factor: 2.778
Authors: J vom Dahl; C Altehoefer; F H Sheehan; P Buechin; G Schulz; E R Schwarz; K C Koch; R Uebis; B J Messmer; U Buell; P Hanrath Journal: J Nucl Med Date: 1997-05 Impact factor: 10.057
Authors: R Sicari; A Ripoli; E Picano; A C Borges; A Varga; W Mathias; L Cortigiani; R Bigi; J Heyman; S Polimeno; O Silvestri; V Gimenez; P Caso; S Severino; A Djordjevic-Dikic; M Ostojic; C Baldi; G Seveso; N Petix Journal: Eur Heart J Date: 2001-05 Impact factor: 29.983
Authors: Rosa Sicari; Eugenio Picano; Lauro Cortigiani; Adrian C Borges; Albert Varga; Caterina Palagi; Riccardo Bigi; Roberta Rossini; Emilio Pasanisi Journal: Am J Cardiol Date: 2003-12-01 Impact factor: 2.778
Authors: E Gordon Depuey; John J Mahmarian; Todd D Miller; Andrew J Einstein; Christopher L Hansen; Thomas A Holly; Edward J Miller; Donna M Polk; L Samuel Wann Journal: J Nucl Cardiol Date: 2012-04 Impact factor: 5.952