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Panminerva Medica 1999 September;41(3):199-206

lingua: Inglese

Lack of prog­nos­tic val­ue of 99mTc ­MIBI ­rest, 18F FDG and 201Tl ­rest/redis­tri­bu­tion on ­PTCA out­come of ­patients ­with mod­er­ate ­left ven­tri­cle dys­func­tion

Rossetti C. 1, Landoni C. 2, Lucignani G. 2, Garraffa G. 2, Ippolito M. 2, Pepi M. 3, Bartorelli A.3, Guazzi M. 3, Savi A. 1, Fazio F. 2,4

From the INB-CNR 4, University of Milan 2, H San Raffaele Institute 1, Institute of Cardiology, University of Milan, “I. Monzino” Foundation ­IRCCS 3, Milan, Italy


Background. The clin­i­cal ­work-out of ­patients under­go­ing cor­o­nary revas­cu­lar­iza­tion ­includes the assess­ment of myo­car­dial viabil­ity. This ­approach has to be ­defined in the dif­fer­ent class­es of ­patients. The aim of ­this ­study was to eval­u­ate the pre­dic­tive prog­nos­tic val­ue of dif­fer­ent tech­niques on out­come fol­low­ing ­PTCA in ­patients ­with mod­er­ate ­left ven­tri­cle dys­func­tion (­left ven­tri­cle EF≥40%).
Methods. Seventeen ­patients ­with EF≥40% and under­go­ing ­PTCA ­were stud­ied by 201Tl ­rest/redis­tri­bu­tion, 18F-FDG and 99mTc-­MIBI ­rest. Regional kine­sis was ­scored by ­echo, divid­ing ­left ven­tri­cle in 11 seg­ments. The ­echo eval­u­a­tion was repeat­ed at 1 and 6 ­months ­after revas­cu­lar­iza­tion.
Results. Global EF was 52.5±7% and 69 seg­ments had abnor­mal kine­sis. Patients under­went ­stress/­rest 99mTc-­MIBI ­SPET, ­rest/redis­tri­bu­tion 201Tl ­SPET and ­rest 18F-FDG PET. Among the 11 seg­ments ­defined on ­echo-­matched tom­o­graph­ic imag­es, the one ­with the high­est activ­ity at ­stress was ­assumed as ref­er­ence (activ­ity=100%). If >50% of refer­ence seg­ment, 18F-FDG and 201Tl ­uptakes ­were con­sid­ered sig­nif­i­cant. After ­PTCA, the ­echo-fol­low-up did not dem­on­strat­ed sig­nif­i­cant improve­ment of ­left ven­tri­cle func­tion at 30 ­days ­after ­PTCA (EF 56±6%) as ­well as at 6 ­months (EF 56±9%). The pos­i­tive pre­dic­tive val­ue ­under ­these con­di­tions result­ed: 46.5% ­with 99mTc-­MIBI ­rest, 47.4% ­with 201Tl ­rest-redis­tri­bu­tion and 45.7% ­with 18F-FDG.
Conclusions. In sum­mary, in the ­class of ­patients ­with mod­er­ate­ly com­pro­mised func­tion, con­sid­er­ing as refer­ence the ­improved region­al kine­sis ­after ­PTCA, 99mTc-MIBl at ­rest, 201Tl ­rest/redis­tri­bu­tion and 18F-FDG do not exhib­it a ­clear pre­dic­tive val­ue; ­patient pop­u­la­tion is ­then a high­ly rel­e­vant ­point to estab­lish the accu­ra­cy of ­these diag­nos­tic pro­ce­dures.

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