Prognostic value of hibernating myocardium and cardiac remodeling using gated 99mTc-MIBI SPECT and gated 18F-FDG PET in patients with ischemic heart failure and diabetes

Abstract Background The prognostic value of hibernating myocardium (HM) and left ventricular (LV) remodeling in patients with ischemic heart failure (IHF) and diabetes mellitus (DM) remains undetermined. Therefore, we aimed to evaluate the prognostic value of HM and LV remodeling in such patients. Methods A total of 333 consecutive patients with coronary artery disease (CAD) and LV ejection fraction ≤ 35% who underwent gated 99mTc-MIBI single photon emission computed tomography (SPECT) myocardial perfusion imaging (G-MPI) and gated 18F-FDG positron emission tomography (PET) myocardial metabolic imaging at Beijing Anzhen Hospital between April 2016 and February 2019 were enrolled and followed up for a median of 3.6 (range, 0.3–5.1) years. Patients were divided into DM (n = 141) and non-DM (n = 192) groups. HM + was defined as HM > 10%. LV remodeling + was defined as end-systolic volume index ≥ 92 mL/m2 by G-MPI. The endpoint was all-cause death. Results More HM was observed in DM than that in non-DM group (18.0 [10.0, 27.0]% vs. 10.0 [0.5, 20.0]%, P < 0.001, respectively). In DM patients, survival for patients with LV remodeling was lower than that for those without LV remodeling (55.1% ± 10.0% vs. 79.9% ± 7.1%, P = 0.007, respectively), but there was no significant difference in survival between HM + and HM- (P > 0.05). Revascularization was associated with better long-term survival than medical therapy in patients with HM+ (DM+, 87.1% ± 7.6% vs. 45.3% ± 10.4%; DM-, 95.7% ± 2.9% vs. 41.9% ± 10.7%, all P value < 0.001), or LV remodeling+ (DM+, 95.2% ± 4.6% vs. 40.3% ± 10.9%, P = 0.001; DM-, 87.1% ± 9.6% vs. 52.3% ± 8.7%, P = 0.004). Conclusions HM may be more prevalent in IHF patients with DM compared with those non-DM. Assessing HM and LV remodeling using nuclear imaging techniques allowed for risk stratification and guided strategy decision-making in DM patients.