LEFT-VENTRICULAR DILATATION AND MULTIVESSEL CORONARY-ARTERY DISEASE ON THALLIUM-501 SPECT ARE IMPORTANT PROGNOSTIC INDICATORS IN PATIENTS WITH LARGE DEFECTS IN THE LEFT ANTERIOR DESCENDING DISTRIBUTION

This study examines the importance of left ventricular (LV) dilatation , and evidence of multivessel coronary artery disease identified on th allium-201 (TI-201) single-photon emission computed tomographic (SPECT ) scintigrams, for predicting long-term outcome in patients with an ex tensive left anterior descending (LAD) perfusion deficit. Impaired con tractility of the left ventricle determined by low ejection fraction, elevated LV end-systolic volume, and dilatation of the left ventricle are known as major predictors of mortality after myocardial infarction . TI-201 single-photon emission computed tomography primarily reveals status of perfusion/redistribution, but also contains indirect informa tion on LV function. To date, there are no TI-201 SPECT data on impair ed function of the left ventricle (LV dilatation) and extent of perfus ion deficits, discussed together as correlates of survival. patient da ta were prospectively collected in the computer data base at Emery Uni versity. A large perfusion defect involving more than one third of the LAD territory was identified in 291 of 2,652 consecutive patients exa mined with TI-201 SPECT initial and 3-hour redistribution studies. Fol low-up data were obtained for 284 patients (98%) at 38 +/- 14 months. Of the 291 patients, 58 died. The most powerful multivariate correlate s of death were LV dilatation, multivessel disease, and the ratio of t he LAD severity stress score to total severity of SDs stress score. co x model analysis was used to determine correlates of survival. Three-y ear survival for patients with LV dilatation was 73% versus 89% withou t LV dilatation (p <0.001). Three-year survival in patients with 1-ves sel disease (''LAD only'') was 94% versus 78% for multivessel disease (p <0.001). Thus, TI-201 SPECT findings of a large perfusion defect in the LAD coronary artery territory, accompanied by LV dilatation and/o r a thallium-derived diagnosis of multivessel coronary artery disease, are strong prognostic indicators of diminished survival at 3 years.