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The clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in guiding myocardial revascularisation

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Abstract

Introduction

Current myocardial revascularisation guidelines recommend that patients with acute coronary syndromes be timeously revascularised. Despite these class I recommendations, immediate access to timeous revascularisation is often not achievable in low- and middle-income countries (LMIC) and remote regions in high-income countries (HIC). Many patients present late outside of the therapeutic window for guideline-recommended interventions. 2-Deoxy-2-[18F]fluoro-d-glucose (2-[18F]FDG) is a radiopharmaceutical agent used to identify cardiac regions with viable or hibernating myocardium. Viable myocytes with impaired contraction may recover their contractility with successful myocardial revascularisation. However, there are conflicting hard outcomes data on patients with hibernating myocardium who are subsequently revascularised. Whether this management strategy results in improved major adverse cardiovascular events remains uncertain.

Methods

In this narrative review, we will critically appraise the existing body of evidence on whether using 2-[18F]FDG positron emission tomography (PET) in guiding myocardial revascularisation leads to compelling clinical outcomes or not. Furthermore, we will discuss possible reasons for the lack of differences in patient outcomes.

Results

A few randomised controlled trials have challenged the concept of viability testing with 2-[18F]FDG PET. One trial demonstrated that a reduction in mortality could be observed if PET recommendations are followed.

Conclusion

The current evidence is insufficient for clinicians in LMIC or remote areas in HIC without access to catheterisation laboratories to refrain from referring patients for viability imaging.

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Fig. 1

modified from Dilsizian V, Narula J: imaging cardiac metabolism. Atlas of nuclear cardiology. Fourth edition. 2013

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  1. Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, 17 Jubilee Road, Parktown, Johannesburg, 2193, Gauteng, South Africa

    Dineo Mpanya & Nqoba Tsabedze

  2. Division of Clinical Associates/Family Medicine, Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa

    Akinwale Ayeni

  3. Division of Nuclear Medicine, Department of Radiation Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

    Akinwale Ayeni & Stuart More

  4. Department of Nuclear Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

    Bawinile Hadebe

  5. Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

    Mike Sathekge

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Contributions

NT contributed to the conception, design and pertinent insights into the controversies relating to the clinical applications of the subject matter. Furthermore, NT critically reviewed and approved the final manuscript. The manuscript was drafted by DM, and DM, SM, AA and BC reviewed the literature and participated in the critical revision of the article for important intellectual content. DM, NT, MS, SM, AA, and BC all read and approved the final version to be published.

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Correspondence to Dineo Mpanya.

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NT has received consultation fees from Novartis Pharmaceuticals, Novo Nordisk, Boston Scientific, Pfizer, Servier, Phillips, Takeda, AstraZeneca, Acino Health Care Group and Merck. He has also received educational and travel grants from Medtronic, Biotronik, Boston Scientific and Vertice Health Care Group.

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Mpanya, D., Ayeni, A., More, S. et al. The clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in guiding myocardial revascularisation. Clin Transl Imaging 10, 9–22 (2022). https://doi.org/10.1007/s40336-021-00454-9

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