Prognostic value of rest-redistribution tomographic thallium-201 imaging in ischemic cardiomyopathy.
The relation between the presence of viable myocardium by rest-redistribution thallium imaging and prognosis is not well defined. This study examined the prognostic value of rest-redistribution single-photon emission computed tomographic imaging with thallium-201 in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Patients were divided into 2 groups: group 1 patients (n = 47) were treated medically and group 2 patients (n = 38) underwent coronary revascularization. The 2 groups were comparable in the extent of CAD and in LV ejection fraction. Thallium images showed normal tracer uptake in 1 group 1 and 3 group 2 patients, fixed defects in 26 group 1 and 18 group 2 patients, and both reversible and fixed defects in 20 group 1 and 17 group 2 patients (p = NS). Based on analysis of 20 segments/patient, reversible defects were seen in 4 +/- 4 segments/patient in group 1 and 5 +/- 5 segments/patient in group 2 (p = NS). Viable myocardium (defined as normal tracer uptake, reversible defects, or mild fixed defects) was seen in 14 +/- 4 segments/patient in group 1 and 15 +/- 5 segments/patient in group 2 (p = NS). During a mean follow-up of 31 months, there were 16 group 1 (34%) and 6 group 2 (16%) deaths. The annual mortality rate was 13% in group 1 and 6% in group 2. Actuarial survival analysis showed better survival in group 2 than in group 1 (p = 0.056). Thus, viable myocardium in patients with CAD and LV dysfunction is associated with poor prognosis with medical therapy. Coronary revascularization improves prognosis.
Gioia
G
G
Philadelphia Heart Institute, Presbyterian Medical Center, Pennsylvania 19104, USA.
Powers
J
J
Heo
J
J
Iskandrian
A S
AS
D000206:Actuarial Analysis; D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D016757:Death, Sudden, Cardiac; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D015143:Philadelphia / Q000453:epidemiology; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D016277:Ventricular Function, Left
D013794:Thallium Radioisotopes