Rest-redistribution 201-Tl single-photon emission CT imaging for determination of myocardial viability: relationship among viability, mode of therapy, and long-term prognosis.
BACKGROUND
The diagnosis of viable myocardium in the setting of ischemic left ventricular systolic dysfunction might indicate which patients have the greatest prognostic benefit from myocardial revascularization. Single-photon emission CT (SPECT) thallium-201 (201Tl) scintigraphy for the detection of viable myocardium is widely available in the community, but outcome data using this imaging modality are limited.


METHODS
Thirty-seven patients (mean [+/- SD] age, 62+/-12 years) with ischemic left ventricular dysfunction (mean ejection fraction, 30+/-9%) initially referred for rest-redistribution SPECT thallium scintigraphy were evaluated 29+/-19 months after coronary bypass surgery (n = 15) or medical therapy alone (n = 22). The relationship among myocardial viability, mode of therapy, and long-term prognosis was evaluated.


RESULTS
Significant myocardial viability (defined as a viability index [VI] of > 0.5) was present in 19 patients. Among patients with a VI > 0.5, the 48-month actuarial event-free survival was 89+/-10% for patients undergoing surgical revascularization, compared with 0% for the medical treatment subgroup (p = 0.005). In contrast, patients in the low-viability subgroup tended to have intermediate event-free survival rates, which were not statistically different for patients receiving either surgical (62+/-21%) or medical therapy (50+/-14%; p = 0.55).


CONCLUSIONS
Survival is significantly more favorable for surgically revascularized patients with ischemic left ventricular dysfunction and myocardial viability as detected by SPECT 201Tl scintigraphy.
Morse
R W
RW
Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Noe
S
S
Caravalho
J
J
Balingit
A
A
Taylor
A J
AJ
D001510:Bed Rest; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D009204:Myocardial Revascularization; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery
D013794:Thallium Radioisotopes