Cardiovascular Journal of Africa: Vol 30 No 6 (November/December 2019)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019

AFRICA

335

The next phase of our research study is to identify patients

with viability who were subsequently revascularised and to

evaluate the clinical impact of viability testing on functional

cardiovascular outcomes and mortality rate. Gated SPECT

and cardiac PET image analysis and interpretation using

convolutional neural networks promise to be some of the future

directions of nuclear medicine.

Conclusions

Our study demonstrated that F18-FDG PET was able to

identify 55% of patients with ischaemic heart disease who had

viability in more than 10% of the total myocardium when using

a 17-segment model.

The authors thank Mr Desmond Maleeme and Mr Pitso Mokemane at the

CMJAH Nuclear Medicine and Molecular Imaging for technical support,

and Professor Jonathan Levin, Division of Epidemiology and Biostatistics

in the School of Public Health at the University of the Witwatersrand for

statistical support. We acknowledge the role of our colleagues at the CMJAH

and the CHBAH, and thank the Division of Cardiology at the CMJAH and

the HJH for their administrative support.

References

Marshall RC, Tillisch JH, Phelps ME, Huang SC, Carson R, Henze E,

et al.

Identification and differentiation of resting myocardial ischemia

and infarction in man with positron computed tomography, 18F-labeled

fluorodeoxyglucose and N-13 ammonia.

Circulation

1983;

(4): 766–778.

Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps

et al.

Reversibility of cardiac wall-motion abnormalities predicted by

positron tomography.

N Engl J Med

1986;

314

(14): 884–888.

Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viabil-

ity testing and impact of revascularization on prognosis in patients with

coronary artery disease and left ventricular dysfunction: a meta-analysis.

J Am Coll Cardiol

2002;

(7): 1151–1158.

D’Egidio G, Nichol G, Williams KA, Guo A, Garrard L, deKemp R,

al.

Increasing benefit from revascularization is associated with increas-

ing amounts of myocardial hibernation: a substudy of the PARR-2 trial.

J Am Coll Cardiol Cardiovasc Imaging

2009;

(9): 1060–1068.

Abraham A, Nichol G, Williams KA, Guo A, deKemp RA, Garrard L,

et al.

18F-FDG PET imaging of myocardial viability in an experienced

center with access to 18F-FDG and integration with clinical manage-

ment teams: the Ottawa-FIVE substudy of the PARR 2 trial.

J Nucl

Med

2010;

(4): 567–574.

Beanlands RS, Nichol G, Huszti E, Humen D, Racine N, Freeman M,

et al

. F-18-fluorodeoxyglucose positron emission tomography imaging-

assisted management of patients with severe left ventricular dysfunction

and suspected coronary disease: a randomized, controlled trial (PARR-

2).

J Am Coll Cardiol

2007;

(20): 2002–2012.

Ghosh N, Rimoldi OE, Beanlands RS, Camici PG. Assessment of

myocardial ischaemia and viability: role of positron emission tomogra-

phy.

Eur Heart J

2010;

(24): 2984–2995.

Auerbach MA, Schoder H, Hoh C, Gambhir SS, Yaghoubi S, Sayre JW,

et al.

Prevalence of myocardial viability as detected by positron emission

tomography in patients with ischemic cardiomyopathy.

Circulation

1999;

(22): 2921–2926.

Schinkel AF, Bax JJ, Sozzi FB, Boersma E, Valkema R, Elhendy A,

. Prevalence of myocardial viability assessed by single photon emission

computed tomography in patients with chronic ischaemic left ventricular

dysfunction.

Heart

2002;

(2): 125–130.

10. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V,

al.

2014 ESC/EACTS guidelines on myocardial revascularization.

EuroIntervention

2015;

(9): 1024–1094.

11. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP,

Benedetto U,

et al

. 2018 ESC/EACTS guidelines on myocardial revascu-

larization.

Eur Heart J

2019;

(2): 87–165.

12. Ling LF, Marwick TH, Flores DR, Jaber WA, Brunken RC, Cerqueira

MD,

et al.

Identification of therapeutic benefit from revascularization

in patients with left ventricular systolic dysfunction: inducible ischemia

versus hibernating myocardium.

Circ Cardiovasc Imaging

2013;

(3):

363–372.

13. Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-

Nickens P,

et al.

Myocardial viability and survival in ischemic left

ventricular dysfunction.

N Engl J Med

2011;

364

(17): 1617–1625.

14. Berger JS, Brown DL, Becker RC. Low-dose aspirin in patients with

stable cardiovascular disease: a meta-analysis.

Am J Med

2008;

121

(1):

43–49.

15. Srivatsava MK, Indirani M, Sathyamurthy I, Sengottuvelu G, Jain AS,

Shelley S. Role of PET-CT in the assessment of myocardial viability in

patients with left ventricular dysfunction.

Indian Heart J

2016;

(5):

693–699.

… continued from page 330

Professor Manga said: ‘There is growing recognition that

many developing countries are experiencing an increasing

prevalence of chronic diseases of lifestyle such as myocardial

infarction, and South Africa is no exception. Our study

shows that psychosocial aspects are an area of cardiovascular

prevention that deserves more attention.’

Dr David Jankelow, chairman of the SA Heart 2017

congress, commented: ‘We know that the depressed cardiac

patient is at greater risk. We as clinicians need to identify

themmuch earlier, so that they can be referred for appropriate

intervention. Cardiac rehabilitation together with counselling

and reassurance will play an important role as well.’

Professor Fausto Pinto, ESC immediate past president and

course director of the ESC programme in South Africa, said:

‘Psychosocial factors including stress at work, depression and

anxiety contribute to the risk of developing cardiovascular

disease and having a worse prognosis. European prevention

guidelines say that psychosocial risk-factor assessment

should be considered in people with, or at high risk of,

cardiovascular disease to identify possible barriers to lifestyle

change or adherence to medication.’

Source:

European Society of Cardiology Press Office