Circulation, Vol 88, 941-952, Copyright © 1993 by American Heart Association
V Dilsizian, P Perrone-Filardi, JA Arrighi, SL Bacharach, AA Quyyumi, NM Freedman and RO Bonow
BACKGROUND: Stress thallium scintigraphy provides important diagnostic and
prognostic information in patients with coronary artery disease by
demonstrating regional myocardial ischemia. However, if the clinical
question being addressed is whether a region is viable and not whether
there is inducible ischemia, then it may be more reasonable to perform
rest-redistribution imaging rather than stress-redistribution imaging
followed by either reinjection or late redistribution. Therefore, we
determined whether stress-redistribution-reinjection and rest-
redistribution imaging provide the same information regarding myocardial
viability. METHODS AND RESULTS. Both stress-redistribution- reinjection and
rest-redistribution thallium single photon emission computed tomographic
imaging was performed in 41 patients with chronic stable coronary artery
disease, with quantitative analysis of regional thallium activity. Thallium
reinjection was performed immediately after the 3- to 4-hour redistribution
images were completed. Of the 155 myocardial regions with perfusion defects
on the stress images, 91 (59%) were irreversible on conventional 3- to
4-hour redistribution images. When the outcomes of these irreversible
regions were assessed after reinjection and compared with
rest-redistribution images, there was concordance of data regarding
myocardial viability (normal/reversible or irreversible) in 72 of the 91
(79%) irreversible defects. Twenty of the 41 patients also underwent
positron emission tomography at rest with [18F]fluorodeoxyglucose and
[15O]water. In these patients, stress-redistribution-reinjection and rest-
redistribution imaging provided concordant information regarding myocardial
viability in 427 (72%) of 594 myocardial regions and discordance in 167
regions. However, when irreversible thallium defects were further analyzed
according to the severity of the thallium defect in these discordant
regions, 149 of 167 (89%) demonstrated only mild-to- moderate reduction in
thallium activity (51% to 85% of normal activity), and positron emission
tomography verified 98% of these regions to be metabolically active and
viable. Thus, when the severity of thallium activity was considered within
irreversible thallium defects, the concordance between
stress-redistribution-reinjection and rest-redistribution imaging regarding
myocardial viability increased to 94%. CONCLUSIONS. These data indicate
that one of two imaging modalities, either
stress-redistribution-reinjection or rest- redistribution imaging, may be
used for identifying viable myocardium. However, if there are no
contraindications to stress testing, stress- redistribution-reinjection
imaging provides a more comprehensive assessment of the extent and severity
of coronary artery disease by demonstrating regional myocardial ischemia
without jeopardizing information on myocardial viability.
ARTICLES
Concordance and discordance between stress-redistribution-reinjection and rest-redistribution thallium imaging for assessing viable myocardium. Comparison with metabolic activity by positron emission tomography
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.
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