Elsevier

Journal of Nuclear Cardiology

Volume 5, Issue 4, July–August 1998, Pages 378-386
Journal of Nuclear Cardiology

Original article
Combined assessment of left ventricular function and rest-redistribution regional myocardial thallium-201 activity for prognostic evaluation of patients with chronic coronary artery disease and left ventricular dysfunction

https://doi.org/10.1016/S1071-3581(98)90143-XGet rights and content

Abstract

Background. This study evaluated the prognostic value of combined assessment of left ventricular (LV) function and regional myocardial thallium activity in patients with nonrecent myocardial infarction and LV dysfunction.

Methods and Results. Eighty-two patients with previous myocardial infarction (>8 weeks) and echocardiographic evidence of LV dysfunction underwent thallium-201 rest-redistribution tomography and cardiac cathetrization. During the follow-up period (mean 25 months) there were 18 cardiac events (14 deaths and 4 nonfatal myocardial infarctions). Multivariate Cox regression analysis on clinical, angiographic, and thallium variables showed that the number of echocardiographic dysfunctional segments with preserved thallium uptake (≥50% of peak activity; chi-square 11.03; p < 0.005) and age (chi-square 8.12, p < 0.01) were predictive of poor outcome. At incremental analysis, combined echocardiographic and thallium data provided significant additional information to clinical, thallium, and LV functional data, increasing global chisquare value from 22.4 to 31.5 (p < 0.01). Similarly, combined data gave additional information after considering clinical, echocardiographic, and LV functional data, increasing global chisquare from 17.8 to 22.3 (p < 0.05). Differently, the number of diseased vessels at coronary angiography did not add further prognostic information.

Conclusions. In patients with previous myocardial infarction and chronic LV dysfunction, the combination of echocardiographic and thallium rest-redistribution imaging data gives prognostic information incremental to those of clinical and LV functional data and to those of each technique considered separately.

References (31)

  • JJ Bax et al.

    Prediction of recovery of myocardial dysfunction after revascularization

  • T Chua et al.

    Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability: correlation with echocardiography and rest thallium-201 scintigraphy

    J Am Coll Cardiol

    (1994)
  • M Petretta et al.

    Prognostic value of coronary angiography in patients with chronic ischemic left ventricular dysfunction and evidence of viable myocardium at thallium reinjection imaging

    J Nucl Cardiol

    (1997)
  • RO Bonow et al.

    Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction

  • BK Madsen et al.

    Prognostic value of echocardiographic compared to other clinical findings

    Cardiology

    (1995)
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