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Updated: Aug 10, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Prognostic value of tomographic rest-redistribution thallium 201 imaging in medically treated patients with coronary
1Philadelphia Heart Institute, Presbyterian Medical Center, Pa, USA.
Insights
Rest-redistribution thallium imaging identifies myocardial viability. Patients with redistribution (ischemia) show higher mortality than those with fixed defects, indicating prognostic value for tomographic imaging in coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Rest-redistribution thallium imaging aids myocardial viability assessment.
- Its impact on patient outcomes requires further definition.
- This study investigates the prognostic significance of tomographic 201Tl imaging in patients with coronary artery disease and left ventricular dysfunction.
Purpose of the Study:
- To evaluate the prognostic value of tomographic rest-redistribution 201Tl imaging.
- To correlate imaging findings with patient outcomes in medically treated patients.
- To assess the predictive capability of myocardial viability assessment for mortality.
Main Methods:
- 81 medically treated patients with coronary artery disease and left ventricular dysfunction underwent rest-redistribution single-photon emission computed tomographic (SPECT) imaging.
- Quantitative analysis of segmental thallium uptake assessed for normal, reversible, or fixed defects.
- Follow-up data collected to determine cardiac mortality and survival rates.
Main Results:
- 80 patients had abnormal thallium images; 38 showed redistribution (ischemia), and 43 did not (no ischemia).
- Patients with ischemia had significantly more abnormal segments (14 +/- 4) compared to those without (11 +/- 5).
- Over a mean follow-up of 31 months, cardiac death occurred in 58% of patients with ischemia versus 26% without (p < 0.05).
- Multivariate analysis identified redistribution as an independent predictor of mortality (p = 0.03).
Conclusions:
- Rest thallium imaging demonstrating redistribution (hibernating myocardium) predicts higher mortality in patients with left ventricular dysfunction.
- Patients with comparable dysfunction but only fixed defects have better survival.
- SPECT imaging offers a straightforward, potentially cost-effective method for prognostic assessment, similar to PET.
Background:
Previous studies show that rest-redistribution thallium imaging is useful in the assessment of myocardial viability. The impact of such studies on patient outcome is not well defined. This study examined the prognostic value of tomographic rest-redistribution 201T1 imaging in 81 medically treated patients with coronary artery disease and left ventricular dysfunction.
Methods And Results:
Rest-redistribution single-photon emission computed tomographic images were obtained and analyzed quantitatively. The segmental thallium uptake (20 segments per patient) was interpreted as normal, reversible defect, mild to moderate fixed defect, or severe fixed defect. The thallium images were abnormal in 80 patients, with no redistribution (no ischemia) in 43 patients and redistribution (ischemia) in 38 patients. The left ventricular ejection fraction was 27% +/- 8% in patients with no redistribution and 26% +/- 7% in patients with redistribution (difference not significant). In patients with no ischemia, there were 7 +/- 5 severe fixed defects and 5 +/- 4 mild to moderate fixed defects per patient. In patients with ischemia there were 7 +/- 4 reversible defects, 3 +/- 3 mild to moderate fixed defects, and 5 +/- 4 severe fixed defects per patient. The number of any abnormal segments was 11 +/- 5 in patients with no ischemia and 14 +/- 4 in patients with ischemia (p = 0.03). During a mean follow-up of 31 +/- 24 months, there were 11 cardiac deaths in patients with no ischemia (26%) and 22 in patients with ischemia (58%); the survival rate was worse in patients with than without ischemia (p < 0.05). Multivariate Cox survival analysis on important clinical, angiographic, and thallium variables showed that the presence of redistribution was an independent predictor of death (x2 = 5; p = 0.03).
Conclusions:
Patients with left ventricular dysfunction and redistribution on rest thallium imaging, a marker of hibernating myocardium, have a higher mortality rate with medical therapy than do patients with a comparable degree of left ventricular dysfunction but with fixed defects only. Thus observations similar to those made with positron emission tomography can be made in a much more straightforward, simple, and probably cost-effective manner with single-photon emission computed tomography.
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