RT Journal Article
SR Electronic
T1 Prognostic Value of Rest <sup>201</sup>Tl-Dipyridamole Stress <sup>99m</sup>Tc-Sestamibi Gated SPECT for Predicting Patient-Based Clinical Outcomes After Bypass Surgery in Patients with Ischemic Left Ventricular Dysfunction
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1735
OP 1740
VO 44
IS 11
A1 Won Jun Kang
A1 Dong Soo Lee
A1 Jin Chul Paeng
A1 Ki-Bong Kim
A1 June-Key Chung
A1 Myung Chul Lee
YR 2003
UL http://jnm.snmjournals.org/content/44/11/1735.abstract
AB We investigated the postoperative prognostic value of preoperative myocardial SPECT for predicting clinical outcomes, including event-free survival and functional improvement. Methods: A total of 123 patients with ischemic heart disease and left ventricular dysfunction were enrolled. The ratio of men to women was 103:20, and the mean (±SD) age was 61 ± 8 y. The disease involved 3 vessels in 95 patients, 2 vessels in 27 patients, and 1 vessel in 1 patient. Rest 201Tl-dipyridamole stress 99mTc-sestamibi gated 24-h-delayed SPECT was performed before and 3–4 mo after bypass surgery. With a 20-segment model, a dysfunctional segment was defined as that with systolic wall thickening of &lt;20%. Dysfunctional but viable segments were defined for each viability predictor, including rest thallium uptake of &gt;60%, reversibility score (rest perfusion minus stress perfusion) of &gt;7, systolic wall thickening of &gt;10%, and 24-h-delayed thallium uptake of &gt;60%. Global left ventricular functional improvement was defined as a 5% increase in the left ventricular ejection fraction (LVEF) or a 10-mL decrease in the end-systolic volume (ESV). A long-term follow-up evaluation was performed by chart reviews and telephone interviews over a period of up to 6 y. Cardiac events were defined as cardiac death, myocardial infarction, or heart failure requiring hospitalization. Results: After bypass surgery, the LVEF was improved from 36.4% ± 8.8% (mean ± SD) to 44.3% ± 11.1%, and the ESV was improved from 96.6 ± 46.7 mL (mean ± SD) to 75.1 ± 44.0 mL. Global left ventricular function was improved in 96 patients but not improved in 27. Rest thallium uptake (≥4 segments) and reversibility (≥5 segments) were found to be significant variables in the receiver-operating-characteristic (ROC) curve analysis, with area-under-the-curve (AUC) values of 0.755 (P &lt; 0.05) and 0.735 (P &lt; 0.05), respectively. The values for preserved systolic wall thickening and delayed thallium uptake had no statistical significance. Using a multivariate logistic function, we created a single variable consisting of rest thallium uptake and reversibility; this variable had better prediction power than any other single variable (AUC value for the ROC curve, 0.794). Patients with a higher logistic function value (≥0.84) showed better event-free survival than did those with a lower logistic function value (&lt;0.84) (log-rank test, P &lt; 0.05). Conclusion: The number of viable segments should be &gt;4 for rest 201Tl SPECT or &gt;5 for the reversibility parameter for the prediction of global functional improvement in a patient-based evaluation. With a logistic function created from these parameters, the long-term clinical prognosis after bypass surgery could be predicted by the presence of viability on preoperative rest-stress myocardial SPECT.