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Thallium reinjection versus standard stress/delay redistribution imaging for prediction of cardiac events
N Zafrir1, J A Leppo, C P Reinhardt
1Nuclear Cardiology Unit, Beilinson Medical Center, Petah Tiqva, Israel.
Insights
Thallium reinjection does not improve cardiac event prediction beyond standard stress/delay redistribution imaging. Left ventricular dilation and perfusion defect size are key predictors of cardiac events in patients with coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Thallium reinjection imaging can detect myocardial viability.
- Its prognostic value compared to standard stress/delay redistribution is unclear in general patient populations.
Purpose of the Study:
- To compare thallium reinjection with stress/delay redistribution for predicting cardiac events.
- To evaluate the independent prognostic utility of thallium reinjection.
Main Methods:
- Retrospective analysis of 366 coronary artery disease patients.
- Inclusion of stress/delay redistribution and thallium reinjection scintigraphy.
- Mean follow-up of 33 months.
Main Results:
- Cardiac events occurred in 48 patients.
- Thallium reinjection did not provide additional prognostic information over stress/delay redistribution.
- Left ventricular cavity size, abnormal perfusion defect size, and patient age predicted cardiac events.
Conclusions:
- Thallium reinjection offers no independent prognostic advantage for cardiac events compared to stress/delay redistribution.
- Left ventricular dilation and the size of the post-stress defect are significant predictors of cardiac events.
Objectives:
The purpose of this study was to compare thallium reinjection with standard stress/delay redistribution for the prediction of cardiac events.
Background:
Although thallium reinjection enhances the detection of viable myocardium, its contribution to prognosis over stress/delay redistribution in a general referral population has not been clearly evaluated.
Methods:
This retrospective analysis included 366 consecutive patients with coronary artery disease who underwent stress/delay redistribution imaging and thallium reinjection scintigraphy, with a mean follow-up of 33+/-12 months.
Results:
Cardiac events occurred in 48 patients (40 deaths, 8 myocardial infarctions). Of the 366 original patients, 159 demonstrated ischemia by stress/delay redistribution, 107 showed ischemia by reinjection only, and 100 showed infarction only. Cardiac events occurred in 20 patients (12.6%) with stress/delay redistribution, 13 patients (12%) with ischemia detected by thallium reinjection only and 15 patients (15%) with infarction only. The size of the reversible thallium defect by either stress/delay redistribution imaging or reinjection scintigraphy did not predict cardiac events. Independent predictors of cardiac events included left ventricular cavity size, the size of the abnormal perfusion defect and patient age.
Conclusions:
Thallium reinjection does not contribute independent prognostic utility for cardiac events when compared with stress/delay redistribution. Left ventricular dilation and the size of the post-stress defect were predictors of cardiac events.