Prognostic utility of increased pulmonary thallium uptake in patients without ischemia

Abstract

Background: Although the combination of increased pulmonary thallium uptake and ischemia has demonstrated prognostic utility, the value of pulmonary uptake independent of ischemia has not been evaluated critically. Accordingly, our purpose was to evaluate the prognostic utility of thallium lung uptake in patients who do not have stress-induced defects.

Methods and results: We studied 184 patients who were divided into three groups. Patients with increased pulmonary uptake were grouped into either the normal perfusion (n = 48) or fixed defect (n = 44) scan group and were compared with a third group (n = 92) of control patients who had normal scans and no lung uptake. During a mean follow-up of 23 +/- 13 months, there were 13 cardiac events (death or myocardial infarction) and the incidence per year was 0.6%, 2%, and 12% in the control, normal, and fixed defect groups, respectively (p < 0.00001). Life table analysis demonstrated greater event-free survival rates in the control and normal groups compared with the group with fixed defects. A Cox regression analysis showed that the number of fixed defects (infarct segments) was the most important independent prognostic factor (p < 0.00001) for future cardiac events.

Conclusion: In patients with increased pulmonary thallium uptake and no stress perfusion defects, the prognosis is similar to that of control patients. However, patients with infarct segments and lung uptake have a significantly worse prognosis.