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Presence of reversible ischaemia predicts long term improvement in left ventricular function after revascularisation in patients with ischaemic cardiomyopathy
Journal of Nuclear Cardiology Volume 6, Number 1, Part 2
Abstracts Tuesday morning, April 20, 1999
$43
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23.23
ADVERSE PROGNOSTICMEANING OF VIABILITY DETECTIONWITH SESTAMIBIIN CAD PATIENTSWITHLV DYSFUNCTION.
V I A B I L I T Y ON F D G S P E C T IS R E L A T E D TO IMPROVEMENT OF HEART FAILURE SYMPTOMS AFTER REVASCULARIZATION. J.J.Bax, J.H.Cornel, F.C.Visser, P.M.Fioretti, D.Poldermans, C.A.Visser. Leiden, The Netherlands.
M.Pellegri, R.Sciagr&, S.Sestini, G.M.Santoro, D.Antoniucci. Nuclear Medicine, University of Florence; Florence, Italy. PET and thallium-201 studies have demonstrated that viability detection implies an adverse outcome in chronic CAD patients with LV dysfunction kept on medical therapy. We examined the relation between Sestamibi demonstration of viability using baseline-nitrate SPECT and long-term outcome in 105 patients. The referring cardiologists independently made therapeutic choices. The events considered during follow-up were cardiac death, nonfatal myocardial infarction and untreatable unstable angina or congestive heart failure requiring late revascularization. The follow-up was 27 _ 22 months, during which 21 events were registered. The event rate in patients without viability (group 1)was 7%. In patients with preserved viability, the event rate was 10% in those submitted to complete revascularization (group 2), 45% in those kept on medical therapy (group 3) (p < 0.005 vs. groups 1 and 2), and 32% in those submitted to incomplete revascularization (group 4) (p = 0.05 vs. group 1, p = 0.06 vs. group 2, NS vs. group 3). These data confirm that viability detection with Sestamibi achieves results comparable to PET and thallium-201 also in terms of prognostication. Furthermore, they suggest that complete revascularization is mandatory in patients with chronic CAD and LV dysfunction if they show signs of preserved viability.
Pre-operative
viability
is
related
to
post-operative
improvement of resting LV function. It is unknown whether the improvement in LV function translates in improvement of heart failure (HF) symptoms. We evaluated the relation between pre-operative viability (assessed by FDG SPECT), post-operative change in LV function and post-operative change in HF symptoms. Patients (n=32) with chronic CAD and depressed LVEF, scheduled for revascularization, were studied. A patient was classified viable when _>3 dysfunctional segments were viable on FDG SPECT. LVEF and HF status (NYHA-criteria) were assessed before and 3 months post-revascularization. Results: in 18 patients with >3 viable segments on SPECT, the LVEF improved from 27_+8% to 34_+9% (P<0.05) and the NYHA score from 2.9_+0.3 to 1.5_+0.7 (P<0.01). In 14 patients with <3 viable segments the LVEF (31_+8% vs 31_+8%, NS) and the NYHA score did not improve (2.6_+0.5 vs 2 . 4 + 0 . 7 , NS). Conclusion: patients with substantial viable tissue did improve in LVEF post-operatively; the improvement in LVEF was accompanied by improvement in HF symptoms.
T U E S D A Y A M
23.22
23.24
PRESENCE OF REVERSIBLE ISCHAEMIA PREDICTS LONG TERM IMPROVEMENT 1N LEFT VENTR1CULAR FUNCTION AFTER REVASCULARISATION IN PATIENTS WITH ISCHAEMIC CARDIOMYOPATHY
DOBUTAMINE ECHOCARDIOGRAPHY AND Tc-99m SESTAMIBI SPECT IN THE PREDICTION OF FUNCTIONAL RECOVERY AFTER ACUTE MYOCARDIAL INFARCTION. W. Acampa, A. Cuocolo, L. Spinelli, M. Petretta, E. Nico[ai, L. Vicario, D. Bonaduce. University Federico 11, Napoli, Italy. Myocardial stunning and hibernation contribute to postinfarction left ventricular dysfunction. Identification of" dysfunctional viable myocardium is important considering that functional recovery may be observed spontaneously or following coronary revascularization. Forty-nine patients underwent coronary angiography, low-dose dobutamine echocardiography and rest sestamibi imaging within 10 days after acute myocardial infarction. Of these patients, 19 were revascularized and 30 tl'eated medically. Resting echocardiogram was repeated 8 months later to evaluate functional recovery. In revascularized patients, 61 of 108 a-dyskinetic segments showed functional recovery. In these patients, sensitivity in predicting functional recovery was 87% for sestamibi and 66% for dobutamine echocardiography (p<,001), while specificity and accuracy were comparable. In medically treated patients, 60 of 149 a-dyskinetic segments showed functional recovery. In these patients, sensitivity was comparable with both techniques, whereas specificity and accuracy were higher for dobutamine than sestamibi (90% vs 61%o; p<.001 and 89% vs 74%; p<.01, respectively). The strongest predictor of functional recovery wets sestamibi activity in revascularized patients (p<.001) and inotropic response in medically treated patients (p<.001). In conclusion, dobutamine echocardiography predicts functional recovery after myocardial infarction. However, sestamibi imaging is useful to identify dysfunctional segments without contractile reserve that may benefit by revascularization.
R Senior and A Lahiri. Harrow. UK
Northwick Park Hospital,
We have hy,pothcsised that rcvascularisation (rev) should improvc LV functiou ill paticnts with ischaemic cardiomyopathy who showed evidence of effort induced ischaelnia. Accordingly, treadmill exercise-rest Tc-99m scstamibi SPECT and rest cchocardiography were performed in 57 pts with symptomatic LV dysfunction (LVEF=25:k8%) due to CAD. LV function was assessed by calculating tile sytolic wall thickening index (SWTI). Reversible ischaemia was demonstrated in 11 (49%) out of" 23 pts x\ho underwent Rcv and 18 (54%) out of 34 pts on medical therapy. There was a significant improvement in SWTI (p=0.01) at a mean follow-up period of 14±4 lnonths only in pts with reversible ischaemia who underwent rev. Thus, presence of reversible ischaemia predicted long term ilnprovement in LV function after rev in pts with ischaemic cardionlyopathy.
A P R I L 20
Abstracts Tuesday morning, April 20, 1999
$43
23.21
23.23
ADVERSE PROGNOSTICMEANING OF VIABILITY DETECTIONWITH SESTAMIBIIN CAD PATIENTSWITHLV DYSFUNCTION.
V I A B I L I T Y ON F D G S P E C T IS R E L A T E D TO IMPROVEMENT OF HEART FAILURE SYMPTOMS AFTER REVASCULARIZATION. J.J.Bax, J.H.Cornel, F.C.Visser, P.M.Fioretti, D.Poldermans, C.A.Visser. Leiden, The Netherlands.
M.Pellegri, R.Sciagr&, S.Sestini, G.M.Santoro, D.Antoniucci. Nuclear Medicine, University of Florence; Florence, Italy. PET and thallium-201 studies have demonstrated that viability detection implies an adverse outcome in chronic CAD patients with LV dysfunction kept on medical therapy. We examined the relation between Sestamibi demonstration of viability using baseline-nitrate SPECT and long-term outcome in 105 patients. The referring cardiologists independently made therapeutic choices. The events considered during follow-up were cardiac death, nonfatal myocardial infarction and untreatable unstable angina or congestive heart failure requiring late revascularization. The follow-up was 27 _ 22 months, during which 21 events were registered. The event rate in patients without viability (group 1)was 7%. In patients with preserved viability, the event rate was 10% in those submitted to complete revascularization (group 2), 45% in those kept on medical therapy (group 3) (p < 0.005 vs. groups 1 and 2), and 32% in those submitted to incomplete revascularization (group 4) (p = 0.05 vs. group 1, p = 0.06 vs. group 2, NS vs. group 3). These data confirm that viability detection with Sestamibi achieves results comparable to PET and thallium-201 also in terms of prognostication. Furthermore, they suggest that complete revascularization is mandatory in patients with chronic CAD and LV dysfunction if they show signs of preserved viability.
Pre-operative
viability
is
related
to
post-operative
improvement of resting LV function. It is unknown whether the improvement in LV function translates in improvement of heart failure (HF) symptoms. We evaluated the relation between pre-operative viability (assessed by FDG SPECT), post-operative change in LV function and post-operative change in HF symptoms. Patients (n=32) with chronic CAD and depressed LVEF, scheduled for revascularization, were studied. A patient was classified viable when _>3 dysfunctional segments were viable on FDG SPECT. LVEF and HF status (NYHA-criteria) were assessed before and 3 months post-revascularization. Results: in 18 patients with >3 viable segments on SPECT, the LVEF improved from 27_+8% to 34_+9% (P<0.05) and the NYHA score from 2.9_+0.3 to 1.5_+0.7 (P<0.01). In 14 patients with <3 viable segments the LVEF (31_+8% vs 31_+8%, NS) and the NYHA score did not improve (2.6_+0.5 vs 2 . 4 + 0 . 7 , NS). Conclusion: patients with substantial viable tissue did improve in LVEF post-operatively; the improvement in LVEF was accompanied by improvement in HF symptoms.
T U E S D A Y A M
23.22
23.24
PRESENCE OF REVERSIBLE ISCHAEMIA PREDICTS LONG TERM IMPROVEMENT 1N LEFT VENTR1CULAR FUNCTION AFTER REVASCULARISATION IN PATIENTS WITH ISCHAEMIC CARDIOMYOPATHY
DOBUTAMINE ECHOCARDIOGRAPHY AND Tc-99m SESTAMIBI SPECT IN THE PREDICTION OF FUNCTIONAL RECOVERY AFTER ACUTE MYOCARDIAL INFARCTION. W. Acampa, A. Cuocolo, L. Spinelli, M. Petretta, E. Nico[ai, L. Vicario, D. Bonaduce. University Federico 11, Napoli, Italy. Myocardial stunning and hibernation contribute to postinfarction left ventricular dysfunction. Identification of" dysfunctional viable myocardium is important considering that functional recovery may be observed spontaneously or following coronary revascularization. Forty-nine patients underwent coronary angiography, low-dose dobutamine echocardiography and rest sestamibi imaging within 10 days after acute myocardial infarction. Of these patients, 19 were revascularized and 30 tl'eated medically. Resting echocardiogram was repeated 8 months later to evaluate functional recovery. In revascularized patients, 61 of 108 a-dyskinetic segments showed functional recovery. In these patients, sensitivity in predicting functional recovery was 87% for sestamibi and 66% for dobutamine echocardiography (p<,001), while specificity and accuracy were comparable. In medically treated patients, 60 of 149 a-dyskinetic segments showed functional recovery. In these patients, sensitivity was comparable with both techniques, whereas specificity and accuracy were higher for dobutamine than sestamibi (90% vs 61%o; p<.001 and 89% vs 74%; p<.01, respectively). The strongest predictor of functional recovery wets sestamibi activity in revascularized patients (p<.001) and inotropic response in medically treated patients (p<.001). In conclusion, dobutamine echocardiography predicts functional recovery after myocardial infarction. However, sestamibi imaging is useful to identify dysfunctional segments without contractile reserve that may benefit by revascularization.
R Senior and A Lahiri. Harrow. UK
Northwick Park Hospital,
We have hy,pothcsised that rcvascularisation (rev) should improvc LV functiou ill paticnts with ischaemic cardiomyopathy who showed evidence of effort induced ischaelnia. Accordingly, treadmill exercise-rest Tc-99m scstamibi SPECT and rest cchocardiography were performed in 57 pts with symptomatic LV dysfunction (LVEF=25:k8%) due to CAD. LV function was assessed by calculating tile sytolic wall thickening index (SWTI). Reversible ischaemia was demonstrated in 11 (49%) out of" 23 pts x\ho underwent Rcv and 18 (54%) out of 34 pts on medical therapy. There was a significant improvement in SWTI (p=0.01) at a mean follow-up period of 14±4 lnonths only in pts with reversible ischaemia who underwent rev. Thus, presence of reversible ischaemia predicted long term ilnprovement in LV function after rev in pts with ischaemic cardionlyopathy.
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