[Evaluation of prognosis and myocardial ischemia using thallium in myocardial tomoscintigraphy].
Thallium scintigraphy holds a unique position amongst the methods available for evaluating the prognosis of coronary patients: it enables quantification of underperfused myocardium and evaluates already constituted ventricular damage (irreversible necrosis) and areas at risk of future coronary events (viable but ischemic myocardium). In a series of 1,926 patients who underwent exercise stress or dipyridamole Thallium myocardial scintigraphy for angina pectoris and followed up fort an average of 34 months, the following features were observed: the long-term prognosis in patients with normal myocardial scintigraphy (715 patients) was identical to that of a normal population of the same age (0.11% cardiovascular deaths per year) whereas the cardiovascular mortality was 15 times higher in cases with a pathological scintigraphy: finally, the long-term prognosis (cardiovascular deaths, infarcts or secondary revascularisation) was directly related to the severity of the initial lack of Thallium uptake. This method was used to assess the prognosis and evaluate the myocardial ischaemia in 75 patients who underwent complete surgical revascularisation fort ischaemia, 50 of whom had previous myocardial infarction: all patients had at least one arterial bypass graft: 39% of the myocardium was underperfused before revascularisation; this procedure reduced by 80% (p < 0.0001) the zones of reversible underperfusion but also zones of irreversible underperfusion by 17% (p = 0.04). The results were particularly impressive in patients who underwent revascularisation with an arterial pedicle (left and right internal mammary, gastroepiploic alone or in association) as 91% of the ischemic territories recovered on average 13 days after revascularisation.(ABSTRACT TRUNCATED AT 250 WORDS)
Machecourt
J
J
Clinique cardiologique, chirurgie cardiaque et Biophysique et médecine nucléaire, BP 217 CHR Grenoble.
Longère
P
P
Mansour
P
P
Wolf
J E
JE
Borrel
E
E
Blin
D
D
Vanzetto
G
G
Fagret
D
D
Comet
M
M
Denis
B
B
D004176:Dipyridamole; D005500:Follow-Up Studies; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes; D004176:Dipyridamole
Evaluation du pronostic et de l'ischémie myocardique par la tomoscintigraphie myocardique au thallium.