title: Serial dual single-photon emission computed tomography of thallium-201 and iodine-123 beta-methyliodophenyl pentadecanoic acid scintigraphy can predict functional recovery of patients with coronary artery disease after coronary artery bypass graft surgery.
abstract: BACKGROUND
  A mismatch between thallium-201 ((201)Tl) and iodine-123 ((123)I)-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual single-photon emission computed tomography (SPECT) reflects a dysfunctional but viable myocardium, such as stunned or hibernating myocardium, in patients with coronary artery disease (CAD). However, the cardiac function does not always improve after revascularization. The present study aimed to determine whether serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function after coronary artery bypass graft surgery (CABG) in patients with CAD.
  
  
  METHODS
  The study included 98 patients with CAD requiring CABG and having a left ventricular ejection fraction (LVEF) less than 50%. The total defect score (TDS) was calculated from (201)Tl and (123)I-BMIPP dual-SPECT images acquired before and 3 weeks after CABG. The LVEF, left ventricular end-diastolic volume index, and end-systolic volume index were determined by means of contrast left ventriculography before and 6 months after CABG.
  
  
  RESULTS
  After 6 months, LVEF improved by 5% or more in 62 patients (group A) but did not improve in the remaining 36 patients (group B). Baseline Tl-TDS was significantly lower (9.1±4.6 vs. 14.6±6.5, P<0.001), and the mismatch score (BMIPP-TDS-Tl-TDS) was significantly higher (6.9±4.2 vs. 4.2±3.9, P=0.002) in group A than in group B. The extent of change in BMIPP-TDS 3 weeks after CABG compared with that before (delta-BMIPP-TDS) was significantly greater in group A than in group B (-5.9±3.0 vs. 2.8±4.3, P<0.001). Stepwise multivariate analysis selected delta-BMIPP-TDS as a significant independent predictor of improvement in LVEF at 6 months after CABG (multivariate β-coefficient=-0.718, P<0.001). The degree of change in LVEF 6 months after CABG compared with that before significantly and negatively correlated with delta-BMIPP-TDS (r=-0.631, P<0.001).
  
  
  CONCLUSIONS
  The delta-BMIPP-TDS evaluated by serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function during the chronic phase of CAD.
authors.affiliation: aDepartment of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, Maebashi bDepartment of Cardiovascular Surgery, Tsukazaki Hospital, Hyogo cDepartment of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan.
authors.forename: Kishu
authors.initials: K
authors.lastname: Fujita
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D005227:Fatty Acids; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D013794:Thallium Radioisotopes; C049338:iodofiltic acid; C117025:pentadecanoic acid