Michael Merhige, MD, and colleagues from the Department of Nuclear Medicine at SUNY-Buffalo presented the results of a study of 57 patients who had been on lipid-lowering therapy (LLT) for an average of 3 years.
"LLT is routinely recommended for patients with or at risk for coronary artery disease (CAD), but it has been difficult to assess how aggressive to be with this therapy in individual patients," said Merhige. "In our study, PET myocardial perfusion imaging [MPI] showed that CAD continued to progress in one out of four patients who appeared to have adequate control of lipids with LLT therapy. PET MPI allows us to tailor the aggressiveness of medical management to optimize outcomes for individual patients."
CAD is the leading cause of death among both men and women in the United States and affects more than 7 million individuals in this country. More than half a million Americans die each year from CAD and CAD-related illnesses. Medical therapy aimed at reducing CAD typically includes a prescribed combination of a low-fat/low-carbohydrate diet, exercise, cessation of smoking, medications aimed at lowering lipids, and control of additional risk factors such as diabetes and hypertension. Although this therapy reverses the progress of CAD in some patients, others require more aggressive treatment.
"Nuclear medicine physicians with PET MPI capability are uniquely situated to provide cardiologists with an objective assessment of whether LLT in the individual patient is, in fact, effective in arresting or reversing CAD," says Merhige. "PET MPI should be considered routine in assessing the efficacy of LLT in patients with known CAD, because a full 25% of patients who achieve the recommended guidelines under this treatment nevertheless are progressing their CAD and are at risk for clinical events."
Merhige noted that he and his colleagues want to replace the current CAD diagnosis and treatment paradigm of exercise single-positron emission computed tomography (SPECT) followed by angiography followed by coronary artery bypass graft or other surgery with the less invasive, more cost-effective, and outcome-proven paradigm of PET MPI followed by medical management tailored to the individual patient.
The Society of Nuclear Medicine Annual Meeting is being held June 15-19 at the Los Angeles Convention Center, Los Angeles, CA. In addition to educational sessions, the meeting will focus on leading medical developments in the field of nuclear medicine, including radioimmunotherapy with a new class of drugs that target cancer, diagnostic breakthroughs with PET, and other topics. More than 5,000 specialists in the field of nuclear medicine, including scientists, technologists, researchers, and representatives from the medical industry, are expected to attend. The Society of Nuclear Medicine is an international scientific and professional organization with more than 13,000 members dedicated to promoting the science, technology, and practical applications of nuclear medicine. The SNM is based in Reston, VA.
For late-breaking news about the world of nuclear medicine and events at the 49th Annual Society of Nuclear Medicine meeting, visit www.snm.org
Abstract 186. Monday, June 17, 4:50-5:05 p.m. Room 410
Identifying the Level of Lipid-Lowering Therapy Necessary to Arrest or Reverse Coronary Disease Using Positron Emission Tomography
M. E. Merhige, A. B. Shah, J. G. Oliverio, T. Houston, V. Shelton, M. Javier, and A. J. Perna
State University of New York at Buffalo
Buffalo, New York
Abstract No. 186
IDENTIFYING THE LEVEL OF LIPID LOWERING THERAPY NECESSARY TO ARREST OR REVERSE CORONARY DISEASE USING POSITRON EMISSION TOMOGRAPHY.M. E. Merhige*, A. B. Shah, J. G. Oliverio, T. Houston, V. Shelton, M. Javier, A. J. Perna, Michael E. Merhige, M.D., LLC, Amherst, NY; State University of New York at Buffalo, Department of Nuclear Medicine, Buffalo, NY; Michael E. Merhige, M.D., LLC, Buffalo, NY. (202494) Objectives: The optimal intensity of lipid-lowering therapy (LLT) necessary to minimize coronary events is unknown. The purpose of this study was to determine whether myocardial perfusion imaging using positron emission tomography with dipyridamole and 82Rb (PET), could identify treatment failure prior to clinical events by demonstrating progression of coronary disease (CAD) despite LLT. Methods: 57 patients found to have stress induced myocardial perfusion defects on baseline PET were managed with LLT for an average of 3 years. Follow-up PET studies and outcome assessments were then performed. The paired stress PET studies were objectively analyzed with automated software to determine the average uptake of 82Rb in the anterior, septal, inferior, lateral and apical segments normalized to peak myocardial activity. Baseline and follow-up perfusion studies were then compared with the paired t-test, to identify significant improvement or worsening in segmental perfusion in each patient. Results: With successful LLT: 34 patients demonstrated no significant change in perfusion, and 9 demonstrated improvement. These patients had no events. Fourteen patients (25%) showed progression of CAD despite LLT with one acute myocardial infarction in this group. Conclusion: PET identifies patients with progressive CAD who may be at risk for clinical events despite LLT.