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One-Year Effect of Myocardial Revascularization on Resting Left Ventricular Function and Regional Thallium Uptake in Chronic CAD

Nuclear Medicine Center of the National Council of Research (CNR), Department of Biomorphological and Functional Sciences and Institute of Internal Medicine, Cardiology and Heart Surgery, University "Federico II," Naples
Neuromed, Pozzilli, Italy

Correspondence: For correspondence or reprints contact: Alberto Cuocolo, MD, Nuclear Medicine Center of the National Council of Research, University "Federico II,", via Pansini 5-80131 Naples Italy.

ABSTRACT

It is still unclear whether in patients with chronic coronary artery disease (CAD) the improvements in myocardial perfusion and left ventricular (LV) function induced by revascularization persist in the long run. This study was planned to evaluate the 1-yr effects of successful revascularization on myocardial perfusion and LV function in patients with CAD and to assess the accuracy of thallium imaging in the prediction of functional recovery 1 yr after revascularization. Methods: Thirty-eight patients with chronic CAD who were revascularized (experimental group) underwent, while off drugs, ²⁰¹TI tomography, two-dimensional echocardiography and radionuclide angiography before and after a 1-yr follow-up. Twenty-nine patients with similar characteristics who were not revascularized (control group) and completed the 1-yr follow-up were also studied. Regional thallium activity was quantitative, measured in 13 segments per patient. Systolic function was assessed by echocardiography in corresponding segments. Results: In the experimental group, at baseline, on the basis of regional LV function and thallium uptake, 276 segments were normal, 169 dysfunctional-viable and 49 nonviable. After revascularization, the majority (75%) of the dysfunctional-viable segments at baseline showed functional recovery at follow-up, whereas the majority (81%) of the nonviable segments at baseline did not. Simultaneously, LV ejection fraction increased 4 wk after revascularization (from 39% ± 9% to 42% ± 10%, p < O.O1) and remained unchanged after 1-yr (43% ± 8%, p < 0.01 versus baseline study). LV wall-motion score index after 1 yr was reduced (from 1.68 ± 0.4 to 1.42 ± 0.3, p < 0.001) as compared with baseline. Onthecontrary, in the control group, no change in myocardial perfusion and LV function was detected after the 1-yr follow-up. Conclusion: In patients with chronic CAD, successful coronary revascularization induces a stable improvement in myocardial perfusion and LV function, which is still detectable after a 1-yr follow-up. Furthermore, preserved thallium uptake in dysfunctional regions is predictive of functional recovery after revascularization.

Key Words: ischemic left ventricular dysfunction • myocardial perfusion • cardiac function