{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:08:15Z","timestamp":1790014095490,"version":"4.0.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Science and Technology Project of the Health Commission of Tianjin Binhai New Area","award":["2023BWKZ004"],"award-info":[{"award-number":["2023BWKZ004"]}]},{"name":"the Tianjin Key Medical Discipline Construction Project","award":["TJYXZDXK-3-035C"],"award-info":[{"award-number":["TJYXZDXK-3-035C"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n 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). Although the PET perfusion\u2013metabolism mismatch index has long been used to assess myocardial viability, its value in predicting contractile recovery remains controversial. Quantitative metabolic indices based on standardized uptake value (SUV) may provide complementary prognostic information.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-center retrospective cohort study included 53 patients with ICM who underwent preoperative [\n 13<\/jats:sup>\n N]ammonia\/[\n 18<\/jats:sup>\n F]FDG PET\/CT followed by isolated CABG. Conventional perfusion\u2013metabolism indices were compared with SUV-based indices. The evaluated outcomes were postoperative increases in left ventricular ejection fraction (\u0394LVEF) of \u22655% and \u226510% on follow-up echocardiography, and time to first major adverse cardiovascular event (MACE). Each PET parameter was evaluated in a separate multivariable Firth-penalized logistic regression model adjusted a priori for age, baseline LVEF, history of coronary artery disease, and diabetes. The predictive performance was assessed by receiver operating characteristic analysis, and time to MACE by Cox regression with the adjustment of multiple testing and model optimism.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 53 patients, 32 (60.4%) achieved \u0394LVEF \u22655% and 25 (47.2%) achieved \u0394LVEF \u226510%. The infarct-to-non-infarct SUV ratio (SUVR) was associated with \u0394LVEF \u22655% (odds ratio [OR] 1.94 per 0.1-unit increase, 95% confidence interval [CI] 1.28\u20133.25;\n P<\/jats:italic>\n \u2009<\u20090.001;\n q<\/jats:italic>\n \u2009=\u20090.003) and \u0394LVEF \u226510% (OR 1.53, 95% CI 1.11\u20132.29;\n P<\/jats:italic>\n \u2009=\u20090.004;\n q<\/jats:italic>\n \u2009=\u20090.035). For the prediction of \u0394LVEF \u22655%, SUVR had a higher area under the curve (AUC) than the mismatch index (0.83 vs 0.62; DeLong\n P<\/jats:italic>\n \u2009=\u20090.0049;\n q<\/jats:italic>\n \u2009=\u20090.0147). For the prediction of \u0394LVEF \u226510%, the AUCs did not differ (0.73 and 0.63; DeLong\n P<\/jats:italic>\n \u2009=\u20090.200;\n q<\/jats:italic>\n \u2009=\u20090.383). No individual PET parameter was associated with time to first MACE in adjusted Cox models.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n SUVR showed greater discrimination for postoperative \u0394LVEF \u22655% than the conventional perfusion\u2013metabolism mismatch index. This finding supports SUVR as a quantitative adjunct to conventional PET viability assessment and warrants further multicenter validation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0358657","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:24:23Z","timestamp":1790011463000},"page":"e0358657","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative [13N]ammonia\/[18F]FDG PET\/CT predicts left ventricular functional recovery after CABG in ischemic cardiomyopathy: An exploratory study"],"prefix":"10.1371","volume":"21","author":[{"given":"Fukai","family":"Zhao","sequence":"first","affiliation":[{"name":"TEDA International Cardiovascular Hospital, Clinical College of Cardiovascular Diseases, Tianjin Medical University","place":["Tianjin, China"],"department":["Department of Nuclear 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Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Wang","sequence":"additional","affiliation":[{"name":"TEDA International Cardiovascular Hospital, Clinical College of Cardiovascular Diseases, Tianjin Medical University","place":["Tianjin, China"],"department":["Department of Nuclear Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailing","family":"Hsu","sequence":"additional","affiliation":[{"name":"Nuclear Science and Engineering Institute, University of Missouri-Columbia","place":["Columbia, Missouri, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2585-4753","authenticated-orcid":true,"given":"Jianming","family":"Li","sequence":"additional","affiliation":[{"name":"TEDA International Cardiovascular Hospital, Clinical College of Cardiovascular Diseases, Tianjin Medical University","place":["Tianjin, China"],"department":["Department of Nuclear 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Imaging"},{"issue":"10","key":"pone.0358657.ref015","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/S0735-1097(02)02489-0","article-title":"Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function","volume":"40","author":"RSB Beanlands","year":"2002","journal-title":"J Am Coll Cardiol"},{"issue":"12","key":"pone.0358657.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0081991","article-title":"Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting","volume":"8","author":"T Yang","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0358657.ref017","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the european association of cardiovascular imaging","volume":"28","author":"RM Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"issue":"3","key":"pone.0358657.ref018","first-page":"192","article-title":"Interpreting myocardial perfusion scintigraphy using single-photon emission computed tomography. Part 1","volume":"14","author":"M Czaja","year":"2017","journal-title":"Kardiochir Torakochirurgia Pol"},{"issue":"4","key":"pone.0358657.ref019","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1007\/s12350-019-01953-z","article-title":"Potential errors in interpreting hibernation due to FDG scaling?","volume":"28","author":"NP Johnson","year":"2021","journal-title":"J Nucl Cardiol"},{"issue":"12","key":"pone.0358657.ref020","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1001\/jamacardio.2023.3803","article-title":"Viability and outcomes with revascularization or medical therapy in ischemic ventricular dysfunction: a prespecified secondary analysis of the REVIVED-BCIS2 Trial","volume":"8","author":"D Perera","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"12","key":"pone.0358657.ref021","doi-asserted-by":"crossref","first-page":"7814","DOI":"10.21037\/qims-23-159","article-title":"Myocardial infarct size for predicting improvements in cardiac function in patients with ischemic cardiomyopathy following coronary artery bypass grafting","volume":"13","author":"Y Zhao","year":"2023","journal-title":"Quant Imaging Med Surg"},{"issue":"4","key":"pone.0358657.ref022","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0735-1097(03)00789-7","article-title":"The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure","volume":"42","author":"JP Curtis","year":"2003","journal-title":"J Am Coll Cardiol"},{"issue":"36","key":"pone.0358657.ref023","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"TA McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"3","key":"pone.0358657.ref024","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s12350-020-02388-7","article-title":"Absolute resting 13N-ammonia PET myocardial blood flow for predicting myocardial viability and recovery of ventricular function after coronary artery bypass grafting","volume":"29","author":"J Wang","year":"2022","journal-title":"J Nucl Cardiol"},{"key":"pone.0358657.ref025","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.115.004316","article-title":"Prospective evaluation of 18F-FDG uptake in post-ischemic myocardium by simultaneous PET\/MRI as a prognostic marker of functional outcome","volume":"9","author":"C Rischpler","year":"2016","journal-title":"Circ Cardiovasc Imaging"},{"issue":"2","key":"pone.0358657.ref026","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5603\/NMR.a2017.0010","article-title":"Assessment of the myocardial FDG-PET image quality with the use of maximal Standardized Uptake Value myocardial to background index. 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