Document Detail


Prognostic value of persistent thallium-201 defects that become reversible after reinjection in patients with chronic myocardial infarction.
MedLine Citation:
PMID:  9199256     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The presence of defects at stress-redistribution thallium-201 scintigraphy is related to a higher risk of cardiac events. However, the prognostic value of defects that become reversible after reinjection is not known. In this study we evaluated the prognostic contribution of stress-redistribution-reinjection with special regard to 3-hour fixed defects that become reversible after reinjection. METHODS AND RESULTS: We studied 122 patients with chronic myocardial infarction (>2 months) and suspected or known residual ischemia, with stress-redistribution-reinjection planar scintigraphy. Thallium scans were analyzed by three observers (three segments per view, 5-point score) and classified as normal, fixed, and reversible. The lung/heart ratio was also calculated. At a median follow-up of 47 months, 10 patients had hard events (four deaths and six myocardial infarctions) (group I), 12 patients had unstable angina (group II), 12 patients underwent planned coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (group III), and 86 patients had no events (group IV). The presence of fixed defects that became reversible after reinjection did not identify patients at higher risk. The number of reversible defects at 3 hours was significantly higher only in patients who underwent revascularization. Unstable angina was not predicted by any scintigraphic pattern. The variables that were statistically related to hard events by univariate analysis were increased lung uptake, reversible cavity dilation, and the number of fixed defects that remained fixed after reinjection. By Cox multivariate analysis, the strongest predictor of hard events was the presence of more than three fixed defects that remained fixed after reinjection as a marker of irreversible myocardial damage. CONCLUSIONS: (201)Tl reinjection is a useful approach for not only detecting viable myocardium but also risk stratification in patients with chronic myocardial infarction.
Authors:
A Tisselli; P Pieri; G Moscatelli; M Agostini; O Nanni; A Spinelli; P Riva
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  4     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    1997 May-Jun
Date Detail:
Created Date:  1997-08-12     Completed Date:  1997-08-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  195-201     Citation Subset:  IM    
Affiliation:
Nuclear Medicine Department, M. Bufalini Hospital, Cesena, Italy.
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / diagnosis
Electrocardiography
Exercise Test
Female
Follow-Up Studies
Heart / radionuclide imaging*
Humans
Lung / radionuclide imaging
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / complications,  diagnosis,  radionuclide imaging*,  therapy
Myocardial Revascularization
Prognosis
Prospective Studies
Risk Factors
Thallium Radioisotopes / diagnostic use*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes

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