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Reverse Redistribution in Resting Thallium-201 Myocardial Scintigraphy in Chronic Coronary Artery Disease: An Index of Myocardial Viability

Nuclear Medicine Center, Institute of Radiological Science, University Federico II, Naples, Italy
Institute of Clinical Physiology, CNR, Pisa, Italy
First Clinic of Medicine, University Federico II, Naples, Italy
National Cancer Institute, Fond. Sen. G. Pascale, Naples, Italy

Correspondence: For correspondence or reprints contact: L. Pace, MD, trav.priv. Sanseverino 5/A, 80128, Naples, Italy.

ABSTRACT

The aim of this study was to evaluate whether segments with reverse redistribution on rest-redistribution ²⁰¹Tl scintigraphy represent iable tissue or scar. Methods: Nineteen patients (17 men, 2 women; mean age 53 ± 8 yr) with coronary artery disease underwent rest-redistribution ²⁰¹Tl study before coronary revasculanzation. Regional ²⁰¹Tl uptake was analyzed quantitatively. Regional left ventricular wall motion was assessed before and after coronary revascularization using two-dimensional echocardiography and a three-point scale (1 = normal, 2 = hypokinetic, 3 = akinetic/dyskinetic). Two patterns of reverse redistribution were identified: pattern with normal ²⁰¹Tl uptake in rest and abnormal in redistribution images and pattern with abnormal ²⁰¹Tl uptake in rest and a significant decrease in redistribution images. Results: Of the 247 segments analyzed, 85 were classified as normal, 37 as reversible defects, 83 as fixed defects and 42 as reversere distribution (19 RR-A, 23 RR-B). Segments with RR-A differed from those with RR-B in wall motion score (1.4 ± 0.7 versus 2.0 ± 1.0). Electrocardiographic Q-waves were present in 26% of segments with RR-A and in 57% of segments with pattern B. After revascularization, all dyssynergic segments with pattern A showed improved wall motion, while only 40% of segments with pattern B and abnormal wall motion had such improvement. Conclusion: Our results suggest that dyssynergic segments with pattern A should be considered viable, while more caution should be used in classifying those with pattern B.

Key Words: thallium-201 • reverse redistribution • myocardial viability

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