JNM Feature: FDG PET guided management reduces cardiac events

A significant reduction in cardiac events was observed in patients with 18F-FDG PET–assisted management, compared with patients who received standard care in an experienced center with ready access to 18F-FDG and integration with imaging, heart failure, and revascularization teams, according to research published in the April issue of the Journal of Nuclear Medicine.

The PET and Recovery Following Revascularization (PARR 2) was a randomized trial that assessed viability imaging and focused on patients with severe left ventricular dysfunction. The trial demonstrated a trend toward outcome benefit, but this trend did not reach statistical significance.

The sub study of PARR 2 called the Ottawa-FIVE, was a post hoc analysis to determine the benefit of PET in a center with experience, ready access to 18F-FDG and integration with clinical teams.

The Ottawa-FIVE study included 111 patients with left ventricular dysfunction and suspected coronary artery disease being considered for revascularization. The patients had been randomized in PARR 2 to PET-assisted management or standard care (without 18F-FDG PET) and had been enrolled in Ottawa, Canada after Aug. 1, 2002.

In the Ottawa-FIVE subgroup of PARR 2, the cumulative proportion of patients experiencing the composite event of cardiac death, myocardial infarction or cardiac rehospitalization within one year was 19 percent in PET-assisted management, vs. 41 percent in standard care, according to Robert Beanlands, MD, chief of cardiac imaging and colleagues at the University of Ottawa Heart Institute, Ontario, Canada .

In an interview, Beanlands said the reasons why there was a significant outcome benefit in the Ottawa-FIVE study when compared to the main PARR 2 study, which showed a trend toward outcome benefit, but did not reach statistical significance.

“One was that PET was not immediately accessible in all the sites and the second was that although things were centrally read and these reports were provided to the physicians, some sites had more experience than others.” The other reason Beanlands mentioned was that the sites which had experience integrating with the heart failure, revascularization and the imaging teams communicated more directly and this was only true in small number of centers.

Centers where 18F-FDG can be made readily available should consider its routine use for viability detection in patients with ischemic left ventricular dysfunction and should ensure imaging expertise, access to tracer and close communication with the healthcare team. These measures will facilitate the best use of imaging data toward optimizing patient outcomes, concluded Beanlands and colleagues.