title: Prognostic values of perfusion-metabolic mismatch in Tl-201 and BMIPP scintigraphic imaging in patients with chronic coronary artery disease and left ventricular dysfunction undergoing revascularization.
abstract: OBJECTIVE
  The aim of this study was to assess the prognostic value of the amount of perfusion-metabolic mismatch in revascularized patients with left ventricular (LV) dysfunction by means of Thallium (Tl)-201 and BMIPP imaging.
  
  
  METHODS
  Seventy-six patients with LV dysfunction and coronary artery disease underwent Tl-201 and BMIPP imaging. They were revascularized with either coronary artery bypass graft or balloon angioplasty and were entered into this study. To quantify the amount of perfusion-metabolic mismatch, SPECT images were displayed as polar maps and analyzed semiquantitatively. The patients were followed up for a mean period of 32 months for cardiac mortality and non-fatal cardiac events. Standard follow-up left ventriculography was performed 6 to 12 months after revascularization.
  
  
  RESULTS
  Thirty-two patients exhibited a large amount of perfusion-metabolic mismatch (> 7 segments, group A), 28 patients had a small amount of perfusion-metabolic mismatch (2 to 6 segments, group B), and 16 patients were found to have no perfusion-metabolic mismatch (group C). Similar pre-revascularization LVEF of 35 +/- 5%, 34 +/- 8% and 36 +/- 6% increased to 45 +/- 8% (p < 0.0001), to 38 +/- 8% (p < 0.05), and to 36 +/- 3% (n.s.), respectively, after revascularization. The functional improvement after revascularization in group A was accompanied by a low rate of cardiac events during follow-up and better cardiac event free survival as judged by the Kaplan-Meier method (p < 0.05, vs. group B and C).
  
  
  CONCLUSIONS
  In revascularized patients with severe LV dysfunction, the presence of a large amount of perfusionmetabolic mismatch evaluated by Tl-201 and BMIPP imaging identifies patients with the best prognosis.
authors.affiliation: Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan. sf-fuku@qa2.so-net.ne.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fukuzawa
authors.forename: Shun
authors.initials: S
authors.lastname: Ozawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shimada
authors.forename: Juji
authors.initials: J
authors.lastname: Sugioka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Inagaki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D005227:Fatty Acids; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C049338:iodofiltic acid