The infarct-to-non-infarct SUV ratio (SUVR) showed greater discrimination for postoperative ΔLVEF ≥5% than the conventional perfusion-metabolism mismatch index, supporting SUVR as a quantitative adjunct to conventional PET viability assessment.
SUVR was significantly associated with postoperative left ventricular ejection fraction increase of ≥5% after CABG.
SUVR was significantly associated with postoperative left ventricular ejection fraction increase of ≥10% after CABG.
SUVR had significantly higher discriminative performance than the conventional perfusion-metabolism mismatch index for predicting ΔLVEF ≥5%.
SUVR and the conventional mismatch index did not differ significantly in discriminating ΔLVEF ≥10%.
No individual PET parameter was associated with time to first major adverse cardiovascular event (MACE) in adjusted Cox regression models.
This was a single-center retrospective cohort study of 53 patients with ischemic cardiomyopathy who underwent preoperative [13N]ammonia/[18F]FDG PET/CT followed by isolated CABG.
The conventional perfusion-metabolism mismatch index had limited discriminative value for predicting ΔLVEF ≥5% compared to SUVR.
This research examines how to better predict which heart failure patients will benefit from coronary artery bypass grafting (CABG) surgery. In patients with ischemic cardiomyopathy — heart failure caused by blocked arteries — doctors need to identify whether the weakened heart muscle is still alive (viable) and likely to recover after surgery, or whether it is permanently scarred and unlikely to improve. PET/CT scans are commonly used for this purpose, traditionally using a measure called the 'perfusion-metabolism mismatch index.' This study tested whether a newer quantitative measure — the ratio of radiotracer uptake in damaged versus healthy heart muscle (called SUVR) — could better predict recovery. In 53 patients who had PET/CT scans before CABG surgery, the researchers found that SUVR was a significantly better predictor of meaningful improvement in heart pumping function (ejection fraction increasing by at least 5%) compared to the traditional mismatch index. The AUC — a measure of predictive accuracy — was 0.83 for SUVR versus only 0.62 for the conventional index, a statistically significant difference. Both measures performed more similarly when predicting a larger improvement of 10% or more. Importantly, neither measure predicted which patients would go on to have serious cardiovascular events like heart attack or stroke after surgery. This research suggests that adding a quantitative SUV-based ratio to standard PET/CT analysis could improve doctors' ability to identify which ischemic cardiomyopathy patients are most likely to see their heart function improve after bypass surgery. However, because this was a small, single-center retrospective study, the authors caution that these findings are exploratory and need to be confirmed in larger, multicenter studies before being adopted into routine clinical practice.
Zhao F, Pang Z, Guo H, Chen Y, Wang J, Hsu B, et al.. (2026). Quantitative [13N]ammonia/[18F]FDG PET/CT predicts left ventricular functional recovery after CABG in ischemic cardiomyopathy: An exploratory study.. PloS one. https://doi.org/10.1371/journal.pone.0358657