Enhanced Detection of Ischemic but Viable Myocardium by the Reinjection of Thallium after Stress-Redistribution Imaging

Dilsizian, Vasken; Rocco, Thomas P.; Freedman, Nanette; Leon, Martin B.; Bonow, Robert O.

doi:10.1056/nejm199007193230301

Cited by 743 publications

(170 citation statements)

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“…Until now, studies addressing the contribution of these techniques to the detection and treatment of viable myocardium have mainly concentrated on their ability to predict the return of contractile function after revascularization. [5][6][7][8] The purpose of the present study was to establish the potential prognostic implications of identifying viable and/or ischemic myocardium by either of these 2 methods in patients with LV ischemic dysfunction. The results can be summarized as follows:…”

Section: Discussionmentioning

confidence: 99%

“…The presence of viable myocardium was evaluated in our study by exercise-redistributionreinjection thallium scintigraphy and by low-dose dobutamine echocardiography. We and others [5][6][7][8][9][10][11] previously showed that both methods accurately predict the return of regional and global LV function after revascularization. The present study demonstrates that, in addition, these 2 methods also provide valuable prognostic information, with significant therapeutic implications.…”

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 99%

“…During the past decade, delineation of viable from nonviable myocardium has become the focus of considerable attention and has fostered the development of several new modalities aimed at predicting the return of LV function after revascularization. Among these modalities, exercise-redistribution-reinjection thallium scintigraphy [5][6][7][8] and low-dose dobutamine echocardiography [7][8][9][10][11] have recently emerged as safe, noninvasive, and accurate means of identifying viable myocardium. Although existing data suggest that both imaging modalities are useful for predicting the return of contractile function after revascularization, few data are currently available on their potential value for predicting long-term survival.…”

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confidence: 99%

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Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

155

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Background-Previous studies showed that thallium scintigraphy and dobutamine echocardiography were accurate, noninvasive ways of predicting contractile recovery after revascularization in patients with left ventricular (LV) dysfunction. However, the prognostic impact of such methods remains uncertain. Methods and Results-We prospectively studied 137 consecutive patients with coronary disease and LV dysfunction who underwent exercise-redistribution-reinjection thallium scintigraphy and dobutamine echocardiography to identify myocardial ischemia and viability. A total of 94 patients subsequently underwent revascularization, and 43 underwent medical treatment. The primary endpoint was cardiac mortality, and mean follow-up was 33Ϯ10 months. Twenty-four patients died of cardiac causes. By Cox's regression analysis, long-term survival was related to the extent of coronary disease, the presence of diabetes, type of treatment, the presence of ischemic myocardium as determined by thallium scintigraphy, and the presence of viable myocardium as determined by both tests. Three-year survival was greater in patients with ischemic myocardium (as determined by thallium scintigraphy) or viable myocardium (as determined by both tests) who underwent revascularization than in the other groups (Pϭ0.018 with thallium; PϽ0.001 with dobutamine). Subgroup analyses indicated that among patients with 1-or 2-vessel disease, only those with ischemic or viable myocardium improved survival after revascularization, whereas in patients with 3-vessel or left main diseases, revascularization always improved survival, albeit more in the presence of ischemic or viable myocardium. Conclusions-Among the parameters commonly available in patients with LV ischemic dysfunction, the presence of ischemic myocardium (as determined by thallium scintigraphy) and that of viable myocardium (as determined by dobutamine echocardiography) are independent predictors of subsequent mortality. These observations may be useful in the preoperative selection of patients for revascularization. (Circulation. 1999;100:141-148.)

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Section: Discussionmentioning

confidence: 99%

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 99%

mentioning

confidence: 99%

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Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

155

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“…Another possibility may be that regions identified on stressredistribution 201 Tl imaging as "fixed" may contain both viable and nonviable myocardium. Recently, Dilsizian et al 18 showed that 201 Tl reinjection identifies a significant volume of viable myocardium within "fixed" defects by stressredistribution-reinjection 201 Tl scintigraphy. Judd et al 7 reported in a canine contrast MRI study that the hyperintense regions on delayed images were generally smaller than the risk region but larger (12%) than regions of necrosis as defined by triphenyltetrazolium chloride staining.…”

Section: Discussionmentioning

confidence: 99%

Early Contrast-Enhanced MRI Predicts Late Functional Recovery After Reperfused Myocardial Infarction

et al. 1999

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Background-We have observed 3 abnormal patterns on contrast-enhanced MRI early after reperfused myocardial infarction (MI): (1) absence of normal first-pass signal enhancement (HYPO), (2) normal first pass signal followed by hyperenhanced signal on delayed images (HYPER), or (3) both absence of normal first-pass enhancement and delayed hyperenhancement (COMB). This study examines the association between these patterns in the first week after MI and late recovery of myocardial contractile function by use of magnetic resonance myocardial tissue tagging. Methods and Results-Seventeen patients (14 men) with a mean age of 53Ϯ12 years were studied after a reperfused first MI. Contrast-enhanced images were acquired immediately after bolus administration of gadolinium and 7Ϯ2 minutes later. Tagged images were acquired at weeks 1 and 7. Circumferential segment shortening (%S) was measured in regions displaying HYPER, COMB, or HYPO contrast patterns and in remote regions (REMOTE) at weeks 1 and 7. At week 1, %S was depressed in HYPER, COMB, and HYPO (9Ϯ8%, 7Ϯ6%, and 5Ϯ4%, respectively) and were less than REMOTE (18Ϯ6%, PϽ0.003). However, in HYPER, %S improved at week 7 from 9Ϯ8% to 18Ϯ5% (PϽ0.001 versus week 1). In contrast, HYPO did not improve significantly (5Ϯ4% to 6Ϯ3%, PϭNS) and COMB tended to improve 7Ϯ6% to 11Ϯ6% (Pϭ0.06). Conclusions-HYPER

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“…16,21 It is thus difficult to establish the value of any new method to assess the functional severity of coronary artery disease, because there is no single unequivocal or gold standard. This is especially true of this study population with intermediate stenosis.…”

Section: Definition Of Inducible Ischemia Based On the Results Of Thementioning

confidence: 99%

Myocardial FFR Fractional Flow Reserve in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

et al. 2013

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INTRODUCTIONAn intermediate coronary lesion on angiography is defined as a luminal narrowing with a diameter stenosis ≥40% but ≤70%. Assessment of a coronary lesion with intermediate severity continues to be a challenge for cardiologists. In the current era of drug-eluting stents (DES), when percutaneous coronary revascularization is achieved with high success, a low complication rate, and excellent long-term patency, 1,2 it might be tempting to treat all suspect lesions with implantation of a DES. However, there are still procedural complications ABSTRACT Background:The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ≥40% to ≤70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR) is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT), Myocardial Perfusion Imaging study (MPI), Quantitative Coronary Angiography (QCA) were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25±11.2 and male patients were 16 (80%), female patients 4 (20%), in all 13 patients with an FFR of <0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. In contrast, 5 of 7 patients with an FFR of >0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35%) patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index of the functional severity of the stenosis and the need for coronary revascularization.

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Enhanced Detection of Ischemic but Viable Myocardium by the Reinjection of Thallium after Stress-Redistribution Imaging

Abstract: These data indicate that the reinjection of thallium improves the detection of ischemic myocardium and that myocardial regions with improved thallium uptake on reinjection imaging represent viable but jeopardized myocardium.

Cited by 743 publications

References 20 publications

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Early Contrast-Enhanced MRI Predicts Late Functional Recovery After Reperfused Myocardial Infarction

Myocardial FFR Fractional Flow Reserve in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

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