title: Rest-redistribution 201-Tl single-photon emission CT imaging for determination of myocardial viability: relationship among viability, mode of therapy, and long-term prognosis.
abstract: 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.
authors.affiliation: Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Morse
authors.forename: S
authors.initials: S
authors.lastname: Noe
authors.forename: J
authors.initials: J
authors.lastname: Caravalho
authors.forename: A
authors.initials: A
authors.lastname: Balingit
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
mesh_terms: 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
chemical_list: D013794:Thallium Radioisotopes