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. 2018 Jul 23:12:1179546818790562.
doi: 10.1177/1179546818790562. eCollection 2018.

The Significance of Thallium-201-Chloride SPECT Myocardial Perfusion Imaging in the Management of Patients With Stable Chronic Coronary Artery Disease

Ivan Jurić  1 , Emir Fazlibegović  1 , Danijel Pravdić  1 , Boris Starčević  2 , Ante Punda  3 , Dražen Huić  4 , Mustafa Hadžiomerović  1 , Damir Rozić  1 , Marko Martinac  5 , Darko Markota  1 , Mirjana Vasilj  1 , Ivan Vasilj  6 , Anshul Saxena  7
Affiliations

The Significance of Thallium-201-Chloride SPECT Myocardial Perfusion Imaging in the Management of Patients With Stable Chronic Coronary Artery Disease

Ivan Jurić et al. Clin Med Insights Cardiol. .

Abstract

Background: Patients with stable coronary artery disease (CAD) can be evaluated for myocardial viability by examining reverse redistribution of Thallium-201 (201TI) through cardiac scintigraphy. There is limited knowledge about association of a reverse redistribution with favorable cardiac outcomes. In this study, we hypothesized that higher left ventricular ejection fraction (LVEF), lower myocardial necrosis, fewer ischemic events, and less angina will be associated with reverse redistribution of 201TI imaging.

Methods: Adult patients with stable CAD included in this study underwent exercise-redistribution Thallium single-photon emission computed tomography (SPECT) and were followed for one year. LVEF and regional wall motion abnormalities were evaluated with echocardiography, exercise duration by bicycle testing, and myocardial ischemia and viability by Thallium SPECT.

Results: We studied 159 patients (87 men, 72 women, median age 60 years, range: 38-84) with well-developed collaterals. Those with reverse redistribution on SPECT (n = 61, 38.3%) had significantly better exercise tolerance (⩾85%; P < .001). Subjects with reverse redistribution had better LVEF (P < .001), wall motion parameters (P < .001), a lower degree of myocardial necrosis (P < .05), less angina during follow-up (P = .02), and fewer ischemic events whether treated with OMT or PCI (P < .001).

Conclusions: Reverse redistribution of 201Tl on scintigraphic images is a predictor of myocardial viability. Evidence from our study suggests that optimally treated chronic CAD patients with reverse redistribution may have lower likelihood of future adverse cardiovascular events and better prognosis.

Keywords: PCI; angioplasty; collateral circulation; coronary artery disease; scintigraphy.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
SPECT heart with 201Tl/scintigraphic images of reverse redistribution: second, fourth and sixth order (redistribution): visible perfusion defect infero-apical segment 3 hours after the load. The first, third and fifth row (immediately after the load): no perfusion defect.
Figure 2.
Figure 2.
Flowchart of inclusion and exclusion of patients, and patient characteristics.
Figure 3.
Figure 3.
Survival curves showing survival probabilities over time (in days) among patients with the presence of reverse redistribution.
See this image and copyright information in PMC

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