ORIGINAL ARTICLES   

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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.