Long-term prognostic value of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular dysfunction and coronary artery bypass surgery
| Autor: | Gursurer, M, Emre, AE, Gercekoglu, H, Uslubas, S, Aksoy, M, Ersek, B |
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| Přispěvatelé: | Zonguldak Bülent Ecevit Üniversitesi |
| Jazyk: | angličtina |
| Rok vydání: | 2002 |
| Předmět: | |
| Popis: | WOS: 000176545900007 PubMed: 12108908 Objectives: This study sought to evaluate the long-term prognostic significance of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular (LV) dysfunction and coronary artery bypass surgery. Background: Preoperative stress-redistribution-reinjection TI-201 imaging detects viable but asynergic segments which show functional improvement postoperatively and is considered as a valuable noninvasive method in selection of patients with severe LV dysfunction for revascularization. The long-term prognostic value of the reinjection technique remains unclear. Methods: Fifty-two patients with severe LV dysfunction (mean ejection fraction (EF) 0.32 +/- 0.03) who underwent coronary artery bypass surgery in 1993-1994 were included in the study. Patients had follow-up 49 :1: 12 months. LV function was assessed by two-dimensional echocardiography. Perfusion was assessed by TI-201 SPECT imaging and was graded on a four-point scale (0 = normal, 3 = absent uptake) using the 20 segment model. Perfusion index was derived by adding the score of all segments and dividing these by 20. Patients were divided into two groups. Group A comprised patients with seven and more dysfunctional viable myocardial segments. Group B included patients with less than seven dysfunctional but viable segments. Results: Mean EF increased from 0.32 +/- 0.03 to 0.46 +/- 0.04. Mean perfusion index did not show a significant difference as a whole during follow-up compared to the early postoperative values (0.9 +/- 0.4 and 1.1 +/- 0.4, p = NS). When adequacy of revascularization was considered, the predictive value of a positive preoperative viability test for functional improvement was 82%. Nineteen cardiac events occurred in group B patients and six in group A patients: six deaths (four from cardiac and two from noncardiac causes), 13 myocardial infarctions (MI). Multivariate Cox survival analysis identified the number of viable segments detected preoperatively (chi(2) = 7.2, p = 0.002), postoperative improvement in Tl-uptake (chi(2) = 6.6, p = 0.01) and functional improvement (chi(2) = 5.3, p = 0.03) postoperatively as independent predictors of cardiac events. Preoperative EF and functional capacity were not associated with cardiac events in long-term prognosis. Conclusion: These data suggest that preoperative stress-redistribution-reinjection TI-201 imaging, specifically the number of viable segments detected preoperatively and postoperative improvement in TI-201 uptake provide important long-term prognostic information in patients with severe LV dysfunction who had coronary artery bypass surgery. |
| Databáze: | OpenAIRE |
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