Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.


OBJECTIVE: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. METHODS: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). RESULTS: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). CONCLUSIONS: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.





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Publication Info

Mentz, Robert J, Mona Fiuzat, Linda K Shaw, Afshin Farzaneh-Far, Christopher M O'Connor and Salvador Borges-Neto (2015). Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction. Open Heart, 2(1). p. e000284. 10.1136/openhrt-2015-000284 Retrieved from

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Robert John Mentz

Associate Professor of Medicine

I am a cardiologist with a clinical and research interest in heart failure (going from Failure to Function), including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps."

I serve our group as Chief of the Heart Failure Section.

I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.

I am the Editor in Chief of the Journal of Cardiac Failure - The official journal of the Heart Failure Society of America.

My research interests are focused on treating co-morbid diseases in heart failure patients and improving outcomes across the cardiovascular spectrum through clinical trials and outcomes research. Below, you will find my specific research interests:

  •     Cardiometabolic disease
  •     Co-morbidity characterization (diabetes, sleep apnea, renal failure) in heart failure
  •     Phenotypic characterization and risk prognostication of patients with heart failure
  •     Role of surrogate and nonfatal endpoints in clinical heart failure trials
  •     Biomarkers in heart failure
  •     Novel pharmacological and non-pharmacological approaches to heart failure
  •     Improving site-based heart failure research

Mona Fiuzat

Adjunct Associate Professor in the Department of Medicine

Afshin Farzaneh-Far

Assistant Consulting Professor in the Department of Medicine

Salvador Borges-Neto

Professor of Radiology


1. Diagnostic and Prognostic Utility of Cardiovascular Nuclear Medicine in  Heart Disease.
2. The Role of Cardiac PET/CT  in Cardiac Sarcoidosis and Ischemic Heart Disease.
3. The Role of Nuclear Cardiology in Diagnosis and Management of Amyloidosis.
4. Left Ventricular Dyssynchrony Evaluation by GSPECT.

I am a Professor of Radiology (Nuclear Medicine) and Internal Medicine at Duke University Medical Center. I also serve as the Medical Director of Nuclear Cardiology at Duke Health System with Duke Heart Center. I received my medical doctorate from the Federal Fluminense University in Brazil. I subsequently completed a Cardiology Fellowship at Antonio Pedro University Hospital in Brazil and a second Fellowship in the Medicine/Cardiovascular division at Brigham and Women's Hospital in Boston. I continued my education with a fellowship in Nuclear Cardiology at the Methodist Hospital Baylor College of Medicine in Houston, Texas and finally in Nuclear Medicine in the Department of Radiology at Duke University Medical Center. I have lectured extensively internationally and have published 130+ publications in peer reviewed scientific professional journals. I am a founding member of the American Society of Nuclear Cardiology, Fellow of the American College of Cardiology, Fellow of the American College of Nuclear Medicine and Fellow of the American Heart Association. My clinical and Research interests include the role of cardiac imaging in predicting outcomes and guiding therapy. I have developed one of the largest Nuclear Cardiology Data Bases in the US. More recently my primarily research interest also includes the use of New Radiopharmaceuticals for the Diagnosis and Treatment of Oncologic Diseases (Theranostics). I have led a Team for the implementation of Diagnosis and Treatment of Neuroendocrine Tumors which became a Center of Reference for this Disease Diagnosis and Treatment with PRRT. serving as the PI for Expanded Access for Therapeutic Use of 177-Lu-DOTAO-Tyr3-Octreotide (Advanced Accelerator Applications SA – AAA) –Compationate Use – “177 Lu-Dotatate for Midgut Neuroendocrine Tumors and 177 Lu-Dotatate for GPENET’. Clinical Trials.Gov. 

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