Brian Mc Ardle1, Tushar Shukla1, Graham Nichol1, Robert A deKemp1, Jordan Bernick1, Ann Guo1, Siok Ping Lim1, Ross A Davies1, Haissam Haddad1, Lloyd Duchesne1, Paul Hendry1, Roy Masters1, Heather Ross1, Michael Freeman1, Karen Gulenchyn1, Normand Racine1, Dennis Humen1, Francois Benard1, Terrence D Ruddy1, Benjamin J Chow1, Lisa Mielniczuk1, Jean N DaSilva1, Linda Garrard1, George A Wells1, Rob S B Beanlands2. 1. From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, (G.N.); Department of Medicine, Divisions of Cardiology, University Health Network and St Michael's Hospital, University of Toronto, Canada (H.R., M.F.); ES Garnett Memorial PET Center, Department of Nuclear Medicine, Hamilton Health Sciences, Canada (K.G.); Department of Medicine, Division of Cardiology, Montréal Heart Institute, Canada (N.R.); Department of Medicine, Division of Cardiology, London Health Sciences Centre, Canada (D.H.); and Department of Molecular Oncology, University of British Columbia, Vancouver, Canada; and Department of Nuclear Medicine and Radiobiology, Division of Nuclear Medicine, Centre hospitalier universitaire de Sherbrooke, Canada (F.B.). 2. From the Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Division of Cardiac Surgery, Department of Surgery and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Canada (B.M., T.S., R.A.D., J.B., A.G., S.P.L., R.A.D., H.H., L.D., P.H., R.M., T.D.R., B.J.C., L.M., J.N.D., L.G., G.A.W., R.S.B.B.); Department of Medicine, Division of General Internal Medicine, University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, (G.N.); Department of Medicine, Divisions of Cardiology, University Health Network and St Michael's Hospital, University of Toronto, Canada (H.R., M.F.); ES Garnett Memorial PET Center, Department of Nuclear Medicine, Hamilton Health Sciences, Canada (K.G.); Department of Medicine, Division of Cardiology, Montréal Heart Institute, Canada (N.R.); Department of Medicine, Division of Cardiology, London Health Sciences Centre, Canada (D.H.); and Department of Molecular Oncology, University of British Columbia, Vancouver, Canada; and Department of Nuclear Medicine and Radiobiology, Division of Nuclear Medicine, Centre hospitalier universitaire de Sherbrooke, Canada (F.B.). rbeanlands@ottawaheart.ca.
Abstract
BACKGROUND: Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)-assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed. Long-term outcomes of viability imaging-assisted management have not previously been evaluated in a randomized controlled trial. METHODS AND RESULTS:PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62-1.07]; P=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54-0.99; P=0.042). CONCLUSIONS: After a 5-year follow-up in patients with left ventricular dysfunction and suspected CAD, overall, PET-assisted management did not significantly reduce cardiac events compared with standard care. However, significant benefits were observed when there was adherence to PET recommendations. PET viability imaging may be best applied when there is likely to be adherence to imaging-based recommendations. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00385242.
RCT Entities:
BACKGROUND: Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)-assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed. Long-term outcomes of viability imaging-assisted management have not previously been evaluated in a randomized controlled trial. METHODS AND RESULTS: PARR-2 randomized patients with severe left ventricular dysfunction and suspected CAD being considered for revascularization or transplantation to standard care (n= 195) versus PET-assisted management (n=197) at sites participating in long-term follow-up. The predefined primary outcome was time to composite event (cardiac death, myocardial infarction, or cardiac hospitalization). After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the standard care arm experienced the composite event (hazard ratio for time to composite event =0.82 [95% confidence interval 0.62-1.07]; P=0.15). When only patients who adhered to PET recommendations were included, the hazard ratio for the time to primary outcome was 0.73 (95% confidence interval 0.54-0.99; P=0.042). CONCLUSIONS: After a 5-year follow-up in patients with left ventricular dysfunction and suspected CAD, overall, PET-assisted management did not significantly reduce cardiac events compared with standard care. However, significant benefits were observed when there was adherence to PET recommendations. PET viability imaging may be best applied when there is likely to be adherence to imaging-based recommendations. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00385242.
Authors: Wael A AlJaroudi; Andrew J Einstein; Farooq A Chaudhry; Steven G Lloyd; Fadi G Hage Journal: J Nucl Cardiol Date: 2015-02-20 Impact factor: 5.952
Authors: Fernanda Erthal; Natasha Aleksova; Aun Yeong Chong; Robert A de Kemp; Rob S B Beanlands Journal: J Nucl Cardiol Date: 2016-07-05 Impact factor: 5.952