From the Cardiology Branch, National Heart, Lung, and Blood Institute,
and the Department of Nuclear Medicine, National Institutes of Health,
Bethesda, Md.
Correspondence to Vasken Dilsizian, MD, National Institutes of Health, 10 Center Dr, Clinical Center, Cardiology Branch, NHLBI, Building 10, Room 7B-15, Bethesda, MD 20892.
Background—In patients with
coronary artery disease, stress-redistribution-reinjection
thallium scintigraphy provides important information
regarding myocardial ischemia and viability. Although both
reversible and mild-to-moderate irreversible thallium defects retain
metabolically active, viable myocardium, we
hypothesized that stress-induced reversible thallium defects may better
differentiate reversible from irreversible regional left
ventricular dysfunction after revascularization.
Methods and Results—Twenty-four patients with chronic
coronary artery disease underwent
prerevascularization and
postrevascularization
exercise-redistribution-reinjection thallium single photon emission CT,
gated MRI, and radionuclide angiography. After
revascularization, mean left
ventricular ejection fraction increased from 30±9% to
37±13% at rest (P<0.001). Before
revascularization, abnormal contraction at rest was
observed in 56 of 110 reversible and 20 of 37 mild-to-moderate
irreversible thallium defects (51% and 54%, respectively). After
revascularization, regional contraction improved in
44 of 56 reversible compared with 6 of 20 mild-to-moderate irreversible
thallium defects (79% and 30%, respectively;
P<0.001). The final thallium content (maximum tracer
uptake on redistribution-reinjection images) was significantly higher
in regions with reversible defects that improved than in those that did
not improve after revascularization (86±16%
versus 66±9%, P<0.001). In contrast, final thallium
content was similar in regions with mild-to-moderate irreversible
defects that improved and in those that did not improve after
revascularization (69±9% versus 65±10%,
P=NS). Furthermore, when asynergic regions were grouped
according to the final thallium content, at 60% threshold value,
functional recovery was observed in 83% of regions with reversible
defects compared with 33% of regions with mild-to-moderate
irreversible defects (P<0.001).
Conclusions—These findings suggest that although both reversible
and mild-to-moderate irreversible thallium defects after stress retain
viable myocardium, the identification of reversible
thallium defect on stress in an asynergic region more accurately
predicts recovery of function after
revascularization. Even at a similar mass of viable
myocardial tissue (as reflected by the final thallium content), the
presence of inducible ischemia is associated with an increased
likelihood of functional recovery.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Stress-Induced Reversible and Mild-to-Moderate Irreversible Thallium Defects
Are They Equally Accurate for Predicting Recovery of Regional Left Ventricular Function After Revascularization?
Key Words: coronary disease • scintigraphy • myocardium • ischemia • revascularization
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