PROGNOSTIC VALUE OF REST-REDISTRIBUTION TOMOGRAPHIC TL-201 IMAGING INISCHEMIC CARDIOMYOPATHY

The relation between the presence of viable myocardium by rest-redistr ibution thallium imaging and prognosis is not well defined. This study examined the prognostic value of rest redistribution single-photon em ission computed tomographic imaging with thallium-201 in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Patients were divided into 2 groups: group 1 patients (n = 47) were tr eated medically and group 2 patients (n = 38) underwent coronary revas cularization. The 2 groups were comparable in the extent of CAD and in LV ejection fraction. Thallium images showed normal tracer uptake in 1 group 1 and 3 group 2 patients, fixed defects in 26 group 1 and 18 g roup 2 patients, and both reversible and fixed defects in 20 group 1 a nd 17 group 2 patients (p = NS). Based on analysis of 20 segments/pati ent, reversible defects were seen in 4 +/- 4 segments/patient in group 1 and 5 +/- 5 segments/patient in group 2 (p = NS), Viable myocardium (defined as normal tracer uptake, reversible defects, or mild fixed d efects) was seen In 14 +/- 4 segments/patient in group 1 and 15 +/- 5 segments/patient in group 2 (p = NS). During a mean follow-up of 31 mo nths, there were 16 group 1 (34%) and 6 group 2 (16%) deaths. The annu al mortality rate was 13% in group 1 and 6% in group 2. Actuarial surv ival analysis showed better survival in group 2 than in group 1 (p = 0 .056). Thus, viable myocardium In patients with CAD and LV dysfunction is associated with poor prognosis with medical therapy. Coronary reva scularization improves prognosis.