PROGNOSIS IN PATIENTS WITH LEFT-VENTRICULAR APICAL ANEURYSM DIAGNOSEDBY TL-201 OR TC-99M SESTAMIBI SPECT IMAGES

The prognosis of patients with left ventricular (LV) aneurysm diagnose d by thallium single-photon emission computed tomography (Tl-SPECT) or technetium-99m sestamibi SPECT (MIBI) has not previously been defined . Of 9,505 Tl or MIBI patients, 139 with apical infarct and probable L V aneurysm on tomographic images were identified. patients were groupe d by the presence of divergent versus parallel LV walls. Divergent wal ls show increasing separation of the walls as they approach the apex o n vertical or horizontal long-axis slices. The degree of the deformati on at the apex (divergent vs parallel walls), extent of impaired myoca rdium (total number of pixels in the defect/total number of pixels in the myocardium x 100%), percentage of reversibility, and segmental and total severity of standard deviations of perfusion defects were calcu lated. Seventy-six patients underwent contrast ventriculography. patie nts with divergent walls (n = 57) were older (p = 0.05), herd lower ej ection fractions (p = 0.012), higher lung uptake (only Tl patients) (p = 0.06), and more frequent ST elevation on the resting electrocardiog ram (p = 0.009) than patients with nondivergent (parallel) walls. For both groups, the percent impaired myocardium was comparably high (44 /- 9% vs 46 +/- 10%). Analysis of asynergic segments in 76 patients wh o underwent contrast ventriculography showed more akinetic, paradoxica l, or aneurysmal segments in the apical region of the left ventricle i n the group with SPECT divergent walls. Cox model analysis showed dive rgence as the significant correlate of death. At 5 years, survival for the group with divergent walls was 52% compared with 75% for those wi th nondivergent walls (p = 0.008). Despite significant apical LV impai rment in both groups, mortality was almost twice as high in the group with divergent walls compared with patients with parallel walls. Thus, patients with LV aneurysm diagnosed by radionuclide SPECT perfusion i maging have a higher mortality when displaying a divergent wall patter n than patients with lesser deformity. (C) 1997 by Excerpta Medica, In c.