Prognostic value of persistent thallium-201 defects that become reversible after reinjection in patients with chronic myocardial infarction

Anna Tisselli, Pierluigi Pieri, Giovanni Moscatelli, Monica Agostini, Oriana Nanni, Aureliano Spinelli, Pietro Riva

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. The presence of defects at stress-redistribution thallium-201 scintigraphy is related to a higher risk of cardiac events. However, the prognostic value of defects that become reversible after reinjection is not known. In this study we evaluated the prognostic contribution of stress-redistribution-reinjection with special regard to 3-hour fixed defects that become reversible after reinjection. Methods and Results. We studied 122 patients with chronic myocardial infarction (> 2 months) and suspected or known residual ischemia, with stress-redistribution-reinjection planar scintigraphy. Thallium scans were analyzed by three observers (three segments per view, 5-point score) and classified as normal, fixed, and reversible. The lung/heart ratio was also calculated. At a median follow-up of 47 months, 10 patients had hard events (four deaths and six myocardial infarctions) (group I), 12 patients had unstable angina (group II), 12 patients underwent planned coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (group III), and 86 patients had no events (group IV). The presence of fixed defects that became reversible after reinjection did not identify patients at higher risk. The number of reversible defects at 3 hours was significantly higher only in patients who underwent revascularization. Unstable angina was not predicted by any scintigraphic pattern. The variables that were statistically related to hard events by univariate analysis were increased lung uptake, reversible cavity dilation, and the number of fixed defects that remained fixed after reinjection. By Cox multivariate analysis, the strongest predictor of hard events was the presence of more than three fixed defects that remained fixed after reinjection as a marker of irreversible myocardial damage. Conclusions. 201Tl reinjection is a useful approach for not only detecting viable myocardium but also risk stratification in patients with chronic myocardial infarction.

Original languageEnglish
Pages (from-to)195-201
Number of pages7
JournalJournal of Nuclear Cardiology
Volume4
Issue number3
DOIs
Publication statusPublished - May 1997

Fingerprint

Thallium
Myocardial Infarction
Unstable Angina
Radionuclide Imaging
Lung
Coronary Balloon Angioplasty
Coronary Artery Bypass
Dilatation
Myocardium
Multivariate Analysis
Ischemia

Keywords

  • Myocardial infarction
  • Prognosis
  • Radionuclide imaging
  • Thallium-201 reinjection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of persistent thallium-201 defects that become reversible after reinjection in patients with chronic myocardial infarction. / Tisselli, Anna; Pieri, Pierluigi; Moscatelli, Giovanni; Agostini, Monica; Nanni, Oriana; Spinelli, Aureliano; Riva, Pietro.

In: Journal of Nuclear Cardiology, Vol. 4, No. 3, 05.1997, p. 195-201.

Research output: Contribution to journalArticle

Tisselli, Anna ; Pieri, Pierluigi ; Moscatelli, Giovanni ; Agostini, Monica ; Nanni, Oriana ; Spinelli, Aureliano ; Riva, Pietro. / Prognostic value of persistent thallium-201 defects that become reversible after reinjection in patients with chronic myocardial infarction. In: Journal of Nuclear Cardiology. 1997 ; Vol. 4, No. 3. pp. 195-201.
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N2 - Background. The presence of defects at stress-redistribution thallium-201 scintigraphy is related to a higher risk of cardiac events. However, the prognostic value of defects that become reversible after reinjection is not known. In this study we evaluated the prognostic contribution of stress-redistribution-reinjection with special regard to 3-hour fixed defects that become reversible after reinjection. Methods and Results. We studied 122 patients with chronic myocardial infarction (> 2 months) and suspected or known residual ischemia, with stress-redistribution-reinjection planar scintigraphy. Thallium scans were analyzed by three observers (three segments per view, 5-point score) and classified as normal, fixed, and reversible. The lung/heart ratio was also calculated. At a median follow-up of 47 months, 10 patients had hard events (four deaths and six myocardial infarctions) (group I), 12 patients had unstable angina (group II), 12 patients underwent planned coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (group III), and 86 patients had no events (group IV). The presence of fixed defects that became reversible after reinjection did not identify patients at higher risk. The number of reversible defects at 3 hours was significantly higher only in patients who underwent revascularization. Unstable angina was not predicted by any scintigraphic pattern. The variables that were statistically related to hard events by univariate analysis were increased lung uptake, reversible cavity dilation, and the number of fixed defects that remained fixed after reinjection. By Cox multivariate analysis, the strongest predictor of hard events was the presence of more than three fixed defects that remained fixed after reinjection as a marker of irreversible myocardial damage. Conclusions. 201Tl reinjection is a useful approach for not only detecting viable myocardium but also risk stratification in patients with chronic myocardial infarction.

AB - Background. The presence of defects at stress-redistribution thallium-201 scintigraphy is related to a higher risk of cardiac events. However, the prognostic value of defects that become reversible after reinjection is not known. In this study we evaluated the prognostic contribution of stress-redistribution-reinjection with special regard to 3-hour fixed defects that become reversible after reinjection. Methods and Results. We studied 122 patients with chronic myocardial infarction (> 2 months) and suspected or known residual ischemia, with stress-redistribution-reinjection planar scintigraphy. Thallium scans were analyzed by three observers (three segments per view, 5-point score) and classified as normal, fixed, and reversible. The lung/heart ratio was also calculated. At a median follow-up of 47 months, 10 patients had hard events (four deaths and six myocardial infarctions) (group I), 12 patients had unstable angina (group II), 12 patients underwent planned coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (group III), and 86 patients had no events (group IV). The presence of fixed defects that became reversible after reinjection did not identify patients at higher risk. The number of reversible defects at 3 hours was significantly higher only in patients who underwent revascularization. Unstable angina was not predicted by any scintigraphic pattern. The variables that were statistically related to hard events by univariate analysis were increased lung uptake, reversible cavity dilation, and the number of fixed defects that remained fixed after reinjection. By Cox multivariate analysis, the strongest predictor of hard events was the presence of more than three fixed defects that remained fixed after reinjection as a marker of irreversible myocardial damage. Conclusions. 201Tl reinjection is a useful approach for not only detecting viable myocardium but also risk stratification in patients with chronic myocardial infarction.

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