Clinical utility and impact of myocardial viability imaging with F-18 FDG positron emission tomography to predict left ventricular function improvement following revascularization in ischemic heart disease : a single center retrospective study.

Recent studies have questioned the benefit of myocardial viability identification and its clinical impact on revascularization decisions. We aimed to evaluate whether F-18 fluorodeoxyglucose (F-18 FDG)-positron emission tomography (PET) influences real-world revascularization decisions and whether PET-defined viability helps predict improvement in ejection fraction (LVEF). We conducted a retrospective chart review of Rubidium-82 (Rb-82)/F-18 FDG PET ischemia and viability studies performed from 2020 to 2024 at our institution. Baseline characteristics including comorbidities, ejection fraction (EF) at 3 months and 1 year and PET study results were evaluated. Among patients with viability, a linear mixed-effects model adjusted for baseline EF was performed to assess temporal changes and treatment strategy interaction. One hundred and eleven patients underwent rest-stress Rb-82 PET with F-18 FDG PET imaging, of whom 99 received FDG for myocardial viability assessment. Among these patients, 65 (65.6%) demonstrated ischemic viable myocardium, while 31 (31.3%) had non-viable myocardium. Viability-positive patients were more likely to undergo revascularization (57% (n = 37) vs. 36% (n = 28) received medical therapy only). At 3-month follow-up, both revascularization and medical therapy were associated with significant improvement in LVEF among viability-positive patients. In contrast, viability-negative patients did not demonstrate significant EF improvement. Among viability-positive patients with both 3-month and 1- year EF measurements (N = 28), linear mixed-effects model adjusted for baseline EF revealed that baseline EF was a strong independent predictor of follow-up EF (p < 0.0001). From 3 months to 1 year, the revascularization group demonstrated a significant increase in EF (+ 4.28%, p = 0.014), whereas the medical therapy group showed a non-significant change (+ 1.40%, p = 0.53). However, the overall EF improvement did not differ significantly between groups after adjustment (p = 0.30). EF changes in viability-negative patients remained non-significant over time. Symptomatic improvement was documented in 55.3% of viability-positive patients. Our single-center experience shows that FDG-PET viability test continues to guide management and decision making regarding revascularization and can predict functional recovery and symptomatic improvement.