title: Relationship between myocardial perfusion-gated SPECT and the performance of coronary revascularization in patients with ischemic cardiomyopathy.
abstract: OBJECTIVE
  Ischemic cardiomyopathy (ICM) is a disease with high morbidity and mortality. There are several published studies on the evolution and prognosis of patients with ICM. However, reports on the therapeutic management in clinical practice are scarce. The aim of this study was to analyze coronary revascularization (CR) performance in patients with ICM and suitable coronary anatomy according to myocardial perfusion stress-rest gated SPECT results.
  
  
  METHODS
  Eighty-seven consecutive patients (mean age, 62.4 y; 20 women), with ischemic heart disease, left ventricular ejection fraction of 40% or less, coronary anatomy suitable for CR, and without previous CR, were evaluated by means of stress-rest gated SPECT.
  
  
  RESULTS
  Sixty-four percent of patients had scintigraphic criteria of viability and 62.1% showed scintigraphic ischemia in stress-rest gated SPECT. Forty-five percent of patients were revascularized, and the remainder received medical treatment only. Coronary revascularization was more frequent in patients with scintigraphic viability (P = 0.012), in those with scintigraphic ischemia (P = 0.007), and in those with low left ventricular end-systolic volume (P = 0.006). Cox regression analysis identified multivessel disease [hazard ratio (HR), 3.3; 95% confidence interval (CI), 4-7.8], summed difference score greater than 4 (HR, 3.9; 95% CI, 1.5-9.8), and left ventricular end-systolic volume less than 120 mL (HR, 3.2; 95% CI, 1.3-8.2) as the best independent predictors of CR treatment.
  
  
  CONCLUSIONS
  In patients with ICM and suitable coronary arteries who are able to perform a stress myocardial perfusion-gated SPECT, the presence of multivessel disease and myocardial ischemia and the absence of severely increased left ventricular volume were associated to a decision of CR.
authors.affiliation: Servei de Cardiologia, Àrea del Cor, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Romero-Farina
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-Gonzalez
authors.forename: Albert
authors.initials: A
authors.lastname: Igual
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications*; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention; D014022:Tissue Survival; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left