[Prognostic value of myocardial perfusion SPECT in multivessel coronary disease patients with left ventricular dysfunction, comparing revascularized and non-revascularized patients].
OBJECTIVE
We investigated the prognostic value of 99mTc-Tetrofosmin myocardial SPECT (99mTc-TF) in dysfunctional multivessel coronary disease patients who underwent revascularization (RV) or only medical treatment (MT).


METHODS
In 78 coronary patients with 2-3 diseased vessels and left ventricular ejection fraction (EF) <= 40% (24 10%), we have assessed the extension of the stress perfusion defect, and percent of reversibility (R) by quantification of stress-rest myocardial SPECT 99mTc-TF bull's eyes (2 days-protocol), lung/heart ratio (LH) calculated in the original stress SPECT images, and EF by equilibrium radionuclide ventriculography obtained at 24 h. A R value >= 8% was used to identify viable (V) patients. A total of 28 patients underwent RV and 50 only received MT. After a mean follow-up of 22.9 20 months (3-60), they were considered as coronary events (CE): cardiac death, non-fatal infarction and heart transplant. CE rate was 20.5% (16/78).


RESULTS
No significant differences were found in the pre-revascularization study characteristics, except a significantly higher mean R value in RV (10.6 9.5%) than in MT patients (6.4 7.8%) p: 0.03, and the main difference was that RV patients showed less CE 2/28 (7%) than the MT group 14/50 (28%) p: 0.02. The CE rate was lower in V patients who underwent RV (6%) than in V patients with MT (45%) p: 0.03, but no significant difference was obtained in non-V patients between RV (7%) and MT (16%) groups. In viable patients, the corresponding survival curves (Kaplan-Meier) showed a CE-free survival at 5 years of 79% in patients RV and of 42% in MT patients, p: 0.03, without significant difference in non-V patients.


CONCLUSIONS
Patients with viable myocardium by myocardial SPECT have a good prognosis after revascularization, and show higher risk of CE if they are only medically treated. Myocardial viability is an indispensable assessment in prognosis evaluation and, above all, in therapeutic decision making in dysfunctional multivessel coronary disease patients.
Casáns Tormo
I
I
Servicios de Medicina Nuclear, Hospital Clínico Universitario, Valencia, Spain. casans ire@gva.es
Llácer Escorhihuela
A
A
Ferrero Cabedo
J A
JA
Otero Coto
E
E
Ciudad Platero
J
J
Manjón Soriano
J
J
D000328:Adult; D000368:Aged; D002470:Cell Survival; D003326:Coronary Circulation; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin