Independent and incremental prognostic value of Tl-201 lung uptake at restin patients with severe postischemic left ventricular dysfunction

Background-An elevated Tl-201 lung uptake after stress is related to an adv erse prognosis. Methods and Results-The functional and prognostic significance of resting T l-201 lung uptake was assessed in 124 consecutive patients with ischemic he art disease and ejection fraction less than or equal to 35% undergoing rest -redistribution tomography to evaluate myocardial viability. Tl-201 lung up take significantly correlated with pulmonary wedge pressure (r=0.66; P<0.01 ) and with a restrictive physiology by Doppler echocardiography (P<0.001). During a 13 +/- 13-month follow-up, 13 patients died and 23 patients requir ed hospitalization as the result of worsening heart failure or nonfatal myo cardial infarction (cumulative events rate 29%). Patients with events had a significantly higher Tl-201 lung/heart ratio (L/H) (P<0.001). A L/H value >0.61 best separated patients with and without events (ROC area under curve 0.82), Event-free survival was significantly lower in patients with L/H >0 .61 (P<0.001); L/H >0.61 (chi(2)=10.8; P<0.001) and a restrictive filling p attern (chi(2)=3.6; P<0.05) were independent predictors of events. The prog nostic value of L/H was incremental over that obtained by clinical, echogra phic and Doppler data (global chi(2)=20.8). Conclusions-In patients with severe postischemic left ventricular dysfuncti on undergoing rest-redistribution Tl-201 imaging, an increased lung tracer uptake showed incremental prognostic value over clinical and other imaging findings, providing clinically useful risk assessment.