Relation between wall thickening on gated perfusion SPECT and functional recovery after coronary revascularization in patients with previous myocardial infarction.
OBJECTIVE
This study aimed to evaluate whether wall thickening analysis by gated perfusion single-photon emission computed tomography (SPECT) is useful in predicting functional recovery after revascularization.


METHODS
Forty-one patients with previous myocardial infarction and left ventricular (LV) dysfunction (ejection fraction, EF, 36+/-6%) who were scheduled for revascularization underwent rest 99mTc-sestamibi gated SPECT.


RESULTS
Of 131 akinetic or dyskinetic segments at baseline echocardiography, 82 (63%) recovered after revascularization. Compared with wall thickening analysis, perfusion imaging provided higher sensitivity (78% vs 50%, P<0.0001) and specificity (80% vs 71%, P<0.0005). Among segments with > or =55% sestamibi uptake (viable), those with detectable wall thickening had a higher likelihood of functional recovery than those with absent wall thickening (95% vs 77%, P<0.05). In segments with improved function, the absence of wall thickening was associated with lower sestamibi activity than was observed when detectable wall thickening was present (58+/-14% vs 71+/-13%, P<0.0005). An increase in EF of > or =5% was detectable in 22 (54%) patients. For the prediction of EF improvement, perfusion imaging provided a higher sensitivity than wall thickening analysis (68% vs 41%, P<0.05), while specificity was not significantly different (68% vs 74%). The prevalence of patients with functional recovery did not change when wall thickening analysis was considered in addition to perfusion status (73% in patients with detectable wall thickening and 70% in those without; P=NS).


CONCLUSIONS
In patients with coronary artery disease, wall thickening analysis by gated perfusion SPECT provides additional information compared with perfusion data for the prediction of segmental functional recovery. However, on a patient basis, wall thickening assessment seems to be of more limited value than perfusion status.
Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy.
Mario
M
Petretta
Giovanni
G
Storto
Wanda
W
Acampa
Valeria
V
Sansone
Laura
L
Evangelista
Letizia
L
Spinelli
Alberto
A
Cuocolo
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D009204:Myocardial Revascularization; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*