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Rest-redistribution 201-Thallium single photon emission computed tomography predicts myocardial infarction and cardiac death in patients with ischemic left ventricular dysfunction

Perrone-Filardi, Pasquale; Pace, Leonardo; Dellegrottaglie, Santo; Corrado, Luigi; Prastaro, Maria; Cafiero, Maria; Caiazzo, Gianluca; Marzano, Antonio; Cesarano, Paolo; Gargiulo, Paola; Paolillo, Stefania; Maglione, Antonio; Petretta, Andrea; Chiariello, Massimo

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 122–128
doi: 10.2459/JCM.0b013e32831a0ea8
Original articles
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The prognostic role of rest-redistribution 201-Thallium imaging has not been extensively investigated in patients with left ventricular ischemic dysfunction.

Objective The aim of this study was to evaluate the ability of rest-redistribution 201-Thallium single photon emission computed tomography to predict cardiac death and occurrence of acute myocardial infarction in patients with ischemic mild-to-moderate left ventricular dysfunction.

Methods One-hundred and twenty-six patients with chronic coronary artery disease and mean left ventricular ejection fraction 39 ± 11% were followed-up for 30 ± 17 months after a rest-redistribution 201-Thallium imaging single photon emission computed tomography. Cardiac death and acute myocardial infarction were considered as major cardiac events.

Results During the follow up, 11 (9%) cardiac deaths and 9 (7%) acute myocardial infarctions occurred. The only variable showing significant difference between patients with and without events was the number of severe irreversible defects (1.7 ± 1.9 versus 0.9 ± 1.2, respectively; P = 0.02). By Kaplan–Meier analysis, the presence of three or less, or more than three severe defects was selected as the best cutoff to identify patients with longer event-free survival from cardiac death or acute myocardial infarction (log rank 19.84; P < 0.0001). When only cardiac death was considered as clinical event, the presence of at least two severe defects best separated patients who died from those who survived (log rank 8.68; P = 0.0032).

Conclusion Rest-redistribution 201-Thallium single photon emission computed tomography provides prognostic information in coronary patients with mild-to-moderate left ventricular dysfunction. The number of severe irreversible defects per patient is a powerful predictor of prognosis.

aDepartment of Internal Medicine, Cardiovascular & Immunological Sciences, Italy

bDepartment of Biomorphological and Functional Sciences, Federico II University, and I.B.B. CNR, Naples, Italy

Received 11 April, 2008

Revised 11 July, 2008

Accepted 19 September, 2008

Correspondence to Pasquale Perrone-Filardi, MD, PhD, Institute of Cardiology, ‘Federico II’ University of Naples, Via S. Pansini, 5, I-80131 Naples, Italy Tel: +39 081 746 2232; fax: +39 081 746 2229; e-mail: fpperron@unina.it

© 2009 Italian Federation of Cardiology. All rights reserved.