Increasing Benefit From Revascularization Is Associated With Increasing Amounts of Myocardial HibernationA Substudy of the PARR-2 Trial
Gianni D'Egidio, HBSc, MD*,
Graham Nichol, MD, MPH ,
Kathryn A. Williams, MS*,
Ann Guo, MEng*,
Linda Garrard, BScN*,
Robert deKemp, PhD*,
Terrence D. Ruddy, MD*,
Jean DaSilva, PhD*,
Dennis Humen, MD ,
Karen Y. Gulenchyn, MD ,
Michael Freeman, MD||,
Normand Racine, MD¶,
Francois Benard, MD#,
Paul Hendry, MD*,
Rob S.B. Beanlands, MD*,* for the PARR-2 Investigators
* National Cardiac PET Centre, Divisions of Cardiology and Cardiac Surgery, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
University of Washington–Harborview Center for Prehospital Emergency Care, Seattle, Washington
Division of Cardiology, London Health Sciences Center, London, Ontario, Canada
ES Garnett Memorial PET Center, Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
|| Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
¶ Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
# Division of Nuclear Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Figure 1 Examples of Images and Reconstructed Polar Maps in an Enrolled Patient
(A) Perfusion (left) and F-18-fluorodeoxyglucose (FDG) (right) imaging in the short-axis (SA), vertical-long-axis (VLA), and horizontal-long-axis (HLA) planes. Reduced perfusion with predominately maintained FDG uptake (mismatch) is noted in the anterior, septal, and lateral walls of the left ventricle (LV). (B) Polar maps (scale is %): top row showing the raw perfusion (left) and raw FDG uptake (right) polar maps; middle row is the normalized perfusion defect and FDG defect; lowest row is the scar score (left) and mismatch score (right). Of the total LV myocardium, 8% was scar, and 20% was mismatch. The interpretation was that there was a large amount of mismatch and that the patient would be expected to improve after revascularization. The patient was referred for revascularization but died within 1 week, awaiting surgery.
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Figure 2 Interaction Hazard Ratios and 95% Confidence Interval at Various Levels of Mismatch Measured as a Continuous Variable
The figure is a derivation from the multivariable model. For those with mismatch of <7% there is no significant difference in the risk of the primary outcome if revascularization is done compared with not done. As mismatch increases (i.e.,  7%), there is a decreased risk of the primary outcome for those who undergo revascularization. For those with mismatch of 7%, there is a 0.46 times lower risk for the primary outcome if revascularization is done.
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