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Clinical Investigations: Miscellaneous |

Rest-Redistribution 201Tl Single-Photon Emission CT Imaging for Determination of Myocardial Viability*: Relationship Among Viability, Mode of Therapy, and Long-term Prognosis

Robert W. Morse, DO; Susan Noe, MD; Joseph Caravalho, Jr., MD; Antonio Balingit, MD; Allen J. Taylor, MD
Author and Funding Information

Affiliations: ,  *From the Cardiology Service (Drs. Morse, Noe, and Taylor), Department of Medicine, Nuclear Medicine Service, and the Department of Radiology (Drs. Caravalho and Balingit), Walter Reed Army Medical Center, Washington, DC.

Affiliations: ,  *From the Cardiology Service (Drs. Morse, Noe, and Taylor), Department of Medicine, Nuclear Medicine Service, and the Department of Radiology (Drs. Caravalho and Balingit), Walter Reed Army Medical Center, Washington, DC.



Chest. 1999;115(6):1621-1626. doi:10.1378/chest.115.6.1621
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Background: The diagnosis of viable myocardium in the setting of ischemic left ventricular systolic dysfunction might indicate which patients have the greatest prognostic benefit from myocardial revascularization. Single-photon emission CT (SPECT) thallium-201 (201Tl) scintigraphy for the detection of viable myocardium is widely available in the community, but outcome data using this imaging modality are limited.

Methods: Thirty-seven patients (mean [± SD] age, 62 ± 12 years) with ischemic left ventricular dysfunction (mean ejection fraction, 30 ± 9%) initially referred for rest-redistribution SPECT thallium scintigraphy were evaluated 29 ± 19 months after coronary bypass surgery (n = 15) or medical therapy alone (n = 22). The relationship among myocardial viability, mode of therapy, and long-term prognosis was evaluated.

Results: Significant myocardial viability (defined as a viability index [VI] of > 0.5) was present in 19 patients. Among patients with a VI > 0.5, the 48-month actuarial event-free survival was 89 ± 10% for patients undergoing surgical revascularization, compared with 0% for the medical treatment subgroup (p = 0.005). In contrast, patients in the low-viability subgroup tended to have intermediate event-free survival rates, which were not statistically different for patients receiving either surgical (62 ± 21%) or medical therapy (50 ± 14%; p = 0.55).

Conclusions: Survival is significantly more favorable for surgically revascularized patients with ischemic left ventricular dysfunction and myocardial viability as detected by SPECT 201Tl scintigraphy.

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