F18-FDG Cardiac PET/CT: An Alternative Tool for Myocardial Viability Determination Prior to Coronary Revascularization Decision in Severe Ventricular Dysfunction

Objective: The aim of our study was to evaluate clinical value and accuracy of Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography as an alternative tool for myocardial viability determination prior to coronary revascularization decision in lower left ventricular ejection fraction patients. Materials and Methods: Between the dates of 01.01.2010 and 10.07.2019, 191 consecutive patients (mean age 64±9.1 years) underwent coronary artery bypass graft operations with severe left ventricular ejection fraction dysfunction with 35% or less. These impaired left ventricular ejection fraction patients were calculated as 4.4%. Myocardial viability was studied by Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography for all cases. Final surgical decision was primarily depended on Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography for the majority of cases. Results: 191 coronary artery bypass graft operations were performed. Perioperative deaths occured in 18 (9.4%) cases. 236 patients with impaired left ventricular ejection fraction and coronary artery disease were evaluated by Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography prior to operation. 191 cases (80.9%) were accepted as canditates for revascularization with multiple viable segments.45 cases (19.1%) presented transmural scar tissue (non-viable) images by Fludeoxyglucose uptake analysis. This group cases were considered to be with non-beneficial results from revascularization. Thus, these patients were referred to medical treatments. Mean number of viable segments on Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography were calculated as 5.2±1.4 for each patient. Conclusions: The presence of myocardial viability is crucial to define reasonable canditates for revascularization in cases with lower left ventricular ejection fraction. Among other preoperative viability detection techniques such as echocardiography and myocardial perfusion scintigraphies, Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography is accepted as the ‘Gold Standart’ for segmental analysis on basis of distinguishing scar tissue from viable components.