Identification and revascularization of hibernating myocardium in angina-free patients with left ventricular dysfunction

We examined 17 angina-free patients with left ventricular dysfunction, referred for surgical decision-making, who presented with no or few signsand symptoms of myocardial ischemia according to treadmill stress test. Oncardiac catheterization they were affected by severe multi- vessel coronaryartery disease; the mean left end-diastolic pressure of this population was26.3 +/− 5.5 mm Hg (mean +/− SD) and their mean ejection fraction was 27.6+/− 4.9% (mean +/− SD). They all were investigated for the presence ofviable myocardium by the combined assessment of cardiac perfusion andmetabolism using single photon emission tomography with [99mTc] labelledhexakis-2-methoxy-isobutyl- isonitrile [99mTc]MIBI/SPET) and positronemission tomography with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG/PET), respectively. Patients were considered for coronary surgery when [18F]FDGwas detectable in at least two cardiac segments with wall motionabnormalities and perfusion defects. Nine patients were operated on, sixwere medically treated and two were scheduled for heart transplantation. Werecorded no in- hospital mortality. At a mean follow-up of 28.4 +/− 9.8(mean +/− SD) months all surgical patients were alive and their NYHAfunctional classes have improved, except in one case. Among the patientsrefused for bypass surgery, three are in stable conditions, three haveworsened clinical statuses and two died while waiting for hearttransplantation. In conclusion, for patients with bypassable coronaries, left ventricular dysfunction and lack of angina, successful coronaryrevascularization may be predicted by the presence of viable myocardiumdemonstrated with positron emission tomography.