Quantitative [13N]ammonia/[18F]FDG PET/CT predicts left ventricular functional recovery after CABG in ischemic cardiomyopathy: An exploratory study
Fukai Zhao, Zekun Pang, Haoran Guo, Yue Chen, Jiao Wang, Bailing Hsu, Jianming Li
Abstract
In patients with ischemic cardiomyopathy (ICM), accurate preoperative identification of viable myocardium is clinically important to identify those who are likely to benefit from coronary artery bypass grafting (CABG).
Introduction
Ischemic cardiomyopathy (ICM), an advanced manifestation of coronary artery disease (CAD), is a leading cause of heart failure. It is characterized predominantly by left ventricular systolic dysfunction due to chronic myocardial hypoperfusion.
Materials and methods
This single-center retrospective study screened consecutive patients who underwent [13N]ammonia/[18F]FDG PET/CT myocardial viability assessment at the Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, between April 2016 and March 2022.
Results
From April 2016 to March 2022, 430 consecutive patients referred for [13N]ammonia/[18F]FDG PET/CT myocardial viability assessment were screened.
Discussion
The principal finding of this study is that SUVR, defined as the ratio of [¹⁸F]FDG uptake in low-perfusion myocardium to that in non-infarct myocardium, remained associated with postoperative LVEF recovery at both ΔLVEF thresholds (≥5% and ≥10%) after prespecified clinical adjustment.
Conclusion
SUVR showed greater discrimination for postoperative ΔLVEF ≥5% than the conventional perfusion–metabolism mismatch index. This finding supports SUVR as a quantitative adjunct to conventional PET viability assessment and warrants further multicenter validation.
Citation: Zhao F, Pang Z, Guo H, Chen Y, Wang J, Hsu B, et al. (2026) Quantitative [13N]ammonia/[18F]FDG PET/CT predicts left ventricular functional recovery after CABG in ischemic cardiomyopathy: An exploratory study. PLoS One 21(9): e0358657. https://doi.org/10.1371/journal.pone.0358657
Editor: Carmelo Caldarella, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, ITALY
Received: May 15, 2026; Accepted: September 3, 2026; Published: September 21, 2026
Copyright: © 2026 Zhao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All deidentified individual-level data underlying the reported findings and the complete R analysis code are provided as Supporting Information files S1 Data and S1 Code. Exact calendar dates and direct identifiers have been removed; analysis-relevant intervals are retained. Figure-generation code is provided as S2 Code.
Funding: This work was supported by the Science and Technology Project of the Health Commission of Tianjin Binhai New Area (Grant No. 2023BWKZ004 to JML; funder website not specified in the award documents) and the Tianjin Key Medical Discipline Construction Project (Grant No. TJYXZDXK-3-035C to JML; funder website not specified in the award documents). The article processing charge was supported by the Science and Technology Project of the Health Commission of Tianjin Binhai New Area and the Tianjin Key Medical Discipline Construction Project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: No authors have competing interests.
