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(Circulation. 2000;102:1795.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Independent and Incremental Prognostic Value of ²⁰¹Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

Claudio Marcassa, MD; Michele Galli, MD; Claudio Baroffio, MD; Ermanno Eleuteri, MD; Riccardo Campini, MD; Pantaleo Giannuzzi, MD

From Salvatore Maugeri Foundation IRCCS, Cardiology Division, Veruno (No), Italy.

Correspondence to Claudio Marcassa, MD, Fondazione Maugeri, via Revislate 13, Veruno 28010, Italy. E-mail cmarcassa{at}fsm.it

Background—An elevated ²⁰¹Tl lung uptake after stress is related to an adverse prognosis.

Methods and Results—The functional and prognostic significance of resting ²⁰¹Tl lung uptake was assessed in 124 consecutive patients with ischemic heart disease and ejection fraction 35% undergoing rest-redistribution tomography to evaluate myocardial viability. ²⁰¹Tl lung uptake significantly correlated with pulmonary wedge pressure (r=0.66; P<0.01) and with a restrictive physiology by Doppler echocardiography (P<0.001). During a 13±13-month follow-up, 13 patients died and 23 patients required hospitalization as the result of worsening heart failure or nonfatal myocardial infarction (cumulative events rate 29%). Patients with events had a significantly higher ²⁰¹Tl lung/heart ratio (L/H) (P<0.001). A L/H value >0.61 best separated patients with and without events (ROC area under curve 0.82). Event-free survival was significantly lower in patients with L/H >0.61 (P<0.001); L/H >0.61 (²=10.8; P<0.001) and a restrictive filling pattern (²=3.6; P<0.05) were independent predictors of events. The prognostic value of L/H was incremental over that obtained by clinical, echographic and Doppler data (global ²=20.8).

Conclusions—In patients with severe postischemic left ventricular dysfunction undergoing rest-redistribution ²⁰¹Tl imaging, an increased lung tracer uptake showed incremental prognostic value over clinical and other imaging findings, providing clinically useful risk assessment.

Key Words: heart failure • prognosis • scintigraphy

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