Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction.

BACKGROUND

We evaluated the incremental prognostic value of viability assessment by nitrate single-photon emission computed tomography (SPECT) in patients with ischemic left ventricular (LV) dysfunction.

METHODS AND RESULTS

One hundred and sixty-four patients with previous myocardial infarction and LV dysfunction (ejection fraction 29% +/- 15%) underwent two Tc-99m sestamibi SPECT studies, under control conditions and after sublingual nitrate administration, for evaluation of myocardial viability. In each patient, viability was defined as the presence of > or = 2 severely dysfunctional segments with preserved tracer uptake (> or = 55% of peak activity). Cardiac death, myocardial infarction, and late (> 2 months) revascularization were considered events. Follow-up was 98% complete at a mean period of 30 +/- 24 months. At baseline SPECT, 119 (73%) patients had evidence of viable myocardium, while 45 (27%) did not. Of these latter patients, 18 (40%) had evidence of viability after nitrate administration. Cardiac events occurred in 58 (35%) patients. Cumulative probability of event-free survival was similar in patients with and without viability at baseline SPECT (log rank 0.3, P = NS), while it was lower in patients with viability at nitrate SPECT compared to those without (log rank 6.3, P < .01). The addition of nitrate SPECT data significantly improved the prognostic power of the model including clinical, functional, angiographic, and baseline SPECT data (P < .01).

CONCLUSIONS

In patients with previous myocardial infarction and LV dysfunction, nitrate SPECT imaging provides incremental prognostic information over those obtained from clinical, functional, angiographic variables, and baseline SPECT data.