COMBINED ASSESSMENT OF LEFT-VENTRICULAR FUNCTION AND REST-REDISTRIBUTION REGIONAL MYOCARDIAL TL-201 ACTIVITY FOR PROGNOSTIC EVALUATION OF PATIENTS WITH CHRONIC CORONARY-ARTERY DISEASE AND LEFT-VENTRICULAR DYSFUNCTION

Background. This study evaluated the prognostic value of combined asse ssment of left ventricular (LV) function and regional myocardial thall ium activity in patients with nonrecent myocardial infarction and LV d ysfunction. Methods and Results. Eighty-two patients with previous myo cardial infarction (>8 weeks) and echocardiographic evidence of LV dys function underwent thallium-201 rest-redistribution tomography and car diac catheterization. During the follow-up period (mean 25 months) the re were IS cardiac events (14 deaths and 4 nonfatal myocardial infarct ions). Multivariate Cox regression analysis on clinical, angiographic, and thallium variables showed that the number of echocardiographic dy sfunctional segments with preserved thallium uptake (greater than or e qual to 50% of peak activity; chi-square 11.03; p < 0.005) and age (ch i-square 8.12, p < 0.01) were predictive of poor outcome. At increment al analysis, combined echocardiographic and thallium data provided sig nificant additional information to clinical, thallium, and LV function al data, increasing global chi-square value from 22.4 to 31.5 (p < 0.0 1). Similarly, combined data gave additional information after conside ring clinical, echocardiographic, and LV functional data, increasing g lobal chi-square from 17.8 to 22.3 (p < 0.05). Differently, the number of diseased vessels at coronary angiography did not add further progn ostic information. Conclusions. Ire patients with previous myocardial infarction and chronic LV dysfunction, the combination of echocardiogr aphic and thallium rest-redistribution imaging data gives prognostic i nformation incremental to those of clinical and LV functional data and to those of each technique considered separately.