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Nuclear Medicine Unit, Department of Clinical Physiopathoiogy, University of Florence, and Division of Cardiology, Careggi Hospital, Florence, Italy
Correspondence: For correspondence or reprints contact: Roberto Sciagrà, MD, Nuclear Medicine Unit, Department of Clinical Physiopathoiogy, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
ABSTRACT
Rest-redistribution 201TI imaging is currently being used for myocardial viability detection, but the ideal parameters for territory classification have not yet been defined. The aim of this study was to define the optimal criteria for detecting viable myocardium and predicting postrevascularization recovery with rest-redistribution 201TI SPECT. Methods: In 29 patients with left ventricular dysfunction, tracer activity within asynergic segments was quantified on rest and redistribution 201TI SPECT. Viability was defined by the presence of functional recovery, which was detected by comparing wall motion in baseline and follow-up echocardiography. Discriminant function analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate the relationship between 201TI data and viability. Results: Of 214 dysfunctioning segments (135 a-/dyskinetic), viability was demonstrated in 115 (75a-/dyskinetic). Both rest and redistribution 201TI activity in these segments were significantly higher than they were in the nonviable segments (p < 0.0001).Significant (> 10%) reversibility was observed in 39% of the viable and in 36% of the nonviable segments (p = 0.81). Discriminant analysis identified redistribution activity, followed by rest activity, as the most effective predictors of functional recovery. Similar areas were found under the ROC curve for rest (0.68 ± 0.037) and for redistribution activity (0.70 ± 0.036)(p =0.13). ROC curve analysis identified the optimal cutoff for redistribution activity at > 60%, with 147 of 214 (69%) segments correctly classified (sensitivity = 78% and specificity = 58%). In the subset of a-/dyskinetic segments, redistribution activity presented a significantly larger ROC curve area (0.81 ± 0.038 compared to 0.77 ± 0.042, p < 0.05), and 103 of 135 (76%) segments were correctly classified (sensitivity = 81% and specificity = 70%). Conclusion: Redistribution activity is the most important parameter to be considered in rest-redistribution 201TI to differentiate viable from nonviable segments; rest activity is also valuable, whereas the meaning of reversibility appears limited. Cutoff values about 60% appear to give the most reasonable balance between sensitivity and specificity.
Key Words: hibernating myocardium • receiver operating characteristic analysis • thallium-201
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