Prognostic value of revascularising viable myocardium in elderly patients with stable coronary artery disease and left ventricular dysfunction: a PET/CT study

Sparse information is available on the role of cardiac viability imaging in elderly patients. We aimed at evaluating the prognostic value of FDG-PET/CT in elderly patients with stable coronary artery disease (CAD) and reduced left ventricular ejection fraction (rLVEF) before revascularisation. Elderly patients (> 65 years old, mean 74 ± 7 years old) with CAD and rLVEF were followed after cardiac FDG-PET/CT and stratified according to presence/absence of viable myocardium and subsequent revascularisation. Fatal events of any cause as well as hospitalisations related to acute cardiac conditions were reported as clinical end-points. Predictors of fatal events in patients with viable myocardium (> 1 myocardium segment/20) were analysed. A total of 89 patients were followed (64 viable myocardia; 37 and 27 patients with and without subsequent revascularisation, respectively). The change in LVEF during follow-up (2.1 ± 1.6 years) was 3.8 ± 6.6% (P = 0.013) and − 0.75 ± 2.6% (P = 0.170) in patients with and without revascularisation, respectively. Log-rank (P = 0.037) and multivariate analysis (Wald: 6.305, P = 0.012) showed viable myocardium to be significantly associated with fatal events if not revascularised. Elderly patients with viable myocardium might potentially benefit from revascularisation procedures as improved left ventricular ejection fraction and survival were observed in our retrospective study as compared to patients in whom a revascularisation procedure was denied. Viable myocardium as detected by cardiac FDG PET/CT was associated with better clinical outcomes in elderly patients when revascularised.