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Incremental Prognostic Value of Thallium Reinjection after Stress-Redistribution Imaging in Patients with Previous Myocardial Infarction and Left Ventricular Dysfunction

Institute of Internal Medicine, Cardiology and Heart Surgery
Department of Nuclear Medicine and Nuclear Medicine Center of the National Research Council, Institute of Radiological Sciences, University of Naples, Naples, Italy

Correspondence: For correspondence or reprints contact: Domenico Bonaduce, MD, Via Aniello Falcone, 394, 80127 Napoli, Italy.

ABSTRACT

This study evaluated the incremental prognostic value of ²⁰¹Tl reinjection imaging over clinical, exercise and thallium stress-redistribution data in patients with previous myocardial infarction and left ventricular dysfunction. Methods: Thallium-201 reinjection after stress-redistribution SPECT was performed in 104 consecutive patients with a first Q-wave myocardial infarction (>8 wk)and left ventricular ejection fraction 40%. Follow-up data (mean 22 mo) were available for 98 patients; 16 patients underwent early revascularization procedures within 3 mo after exercise testing and were not considered for the analysis. Results During follow-up there were 13 hard events (cardiac death and myocardial infarction) and 11 soft events (coronary revascularization procedures >3 mo after thallium imaging). With multivariate Cox regression analysis, the sum of defects at stress-redistribution imaging that were reversible or moderate irreversible after reinjection was a powerful predictor of subsequent events. The addition of thallium reinjection imaging data significantly improved the prognostic power of clinical, exercise and stress-redistribution data for the occurrence of hard events (p < 0.01). Conclusion: In patient switch previous myocardial infarction and left ventricular dysfunction, thallium reinjection imaging provides incremental prognostic information over those obtained from conventional stress-redistribution imaging.

Key Words: myocardial infarction • left ventricular dysfunction • viable myocardium • thallium reinjection imaging

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