Exercise four hour redistribution thallium-201 single photon emission computed tomography and exercise induced ST segment elevation in detecting the viable myocardium in patients with acute myocardial infarction

Objective-To investigate the specificity and sensitivity of the combination of redistribution in exercise thallium-201 single photon emission computed tomography (SPECT) and exercise: induced ST elevation for detecting the vi able myocardium in patients with acute myocardial infarction. Design-37 patients were studied within seven weeks of onset of Q wave myoca rdial infarction (anterior in 22, inferior in 15). All patients underwent e xercise four hour redistribution thallium-201 SPECT and positron emission t omography using fluorine-18-fluorodeoxyglucose (FDG) and nitrogen-13 ammoni a under fasting conditions. Results-Sixteen patients showed exercise induced ST elevation greater than or equal to 1.5 mm, and 15 of these had increased FDG uptake in the infarct region. Eleven of 16 patients (10 of 11 patients with anterior infarctions ) with irreversible thallium-201 defects and increased FDG uptake showed ex ercise induced ST elevation. The sensitivity, specificity, and predictive a ccuracy of redistribution, exercise induced ST segment elevation, or both f or detecting increased FDG uptake were 82%, 75%, and 67% (94%, 75%, and 91% for anterior infarctions), respectively. Conclusions-In patients with acute Q wave myocardial infarction, the combin ation of redistribution in exercise thallium-201 SPECT and exercise induced ST elevation can detect the viable myocardium in the infarct region with h igh sensitivity and specificity, especially in patients with anterior infar ctions.