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Published on: June 11, 2019
Rest-redistribution 201-Thallium single photon emission computed tomography predicts myocardial infarction and
Pasquale Perrone-Filardi1, Leonardo Pace, Santo Dellegrottaglie
1Department of Internal Medicine, Cardiovascular & Immunological Sciences, Italy. fpperron@unina.it
Insights
Rest-redistribution 201-Thallium imaging predicts cardiac events in patients with left ventricular dysfunction. The number of severe irreversible defects on imaging is a strong indicator of prognosis.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Prognostic role of rest-redistribution 201-Thallium imaging in ischemic left ventricular dysfunction is under-investigated.
- Mild-to-moderate left ventricular dysfunction affects prognosis in coronary artery disease.
Purpose of the Study:
- To assess the predictive ability of rest-redistribution 201-Thallium single photon emission computed tomography (SPECT) for cardiac death and myocardial infarction.
- To evaluate prognostic value in patients with ischemic mild-to-moderate left ventricular dysfunction.
Main Methods:
- 126 patients with chronic coronary artery disease and LVEF 39±11% underwent rest-redistribution 201-Thallium SPECT.
- Follow-up duration was 30±17 months, with cardiac death and acute myocardial infarction as primary endpoints.
Main Results:
- 11 cardiac deaths (9%) and 9 acute myocardial infarctions (7%) occurred.
- Severe irreversible defects (≥3) on SPECT were significantly associated with adverse events (P=0.02).
- Kaplan-Meier analysis identified severe defects as a powerful predictor of event-free survival (P<0.0001).
Conclusions:
- Rest-redistribution 201-Thallium SPECT offers valuable prognostic information in coronary patients with mild-to-moderate LV dysfunction.
- The number of severe irreversible defects is a potent predictor of cardiac events.
Unlabelled:
The prognostic role of rest-redistribution 201-Thallium imaging has not been extensively investigated in patients with left ventricular ischemic dysfunction.
Objective:
The aim of this study was to evaluate the ability of rest-redistribution 201-Thallium single photon emission computed tomography to predict cardiac death and occurrence of acute myocardial infarction in patients with ischemic mild-to-moderate left ventricular dysfunction.
Methods:
One-hundred and twenty-six patients with chronic coronary artery disease and mean left ventricular ejection fraction 39 +/- 11% were followed-up for 30 +/- 17 months after a rest-redistribution 201-Thallium imaging single photon emission computed tomography. Cardiac death and acute myocardial infarction were considered as major cardiac events.
Results:
During the follow up, 11 (9%) cardiac deaths and 9 (7%) acute myocardial infarctions occurred. The only variable showing significant difference between patients with and without events was the number of severe irreversible defects (1.7 +/- 1.9 versus 0.9 +/- 1.2, respectively; P = 0.02). By Kaplan-Meier analysis, the presence of three or less, or more than three severe defects was selected as the best cutoff to identify patients with longer event-free survival from cardiac death or acute myocardial infarction (log rank 19.84; P < 0.0001). When only cardiac death was considered as clinical event, the presence of at least two severe defects best separated patients who died from those who survived (log rank 8.68; P = 0.0032).
Conclusion:
Rest-redistribution 201-Thallium single photon emission computed tomography provides prognostic information in coronary patients with mild-to-moderate left ventricular dysfunction. The number of severe irreversible defects per patient is a powerful predictor of prognosis.
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