[Cardiac inotropic reserve examined by postextrasystolic potentiation and redistribution of exercise thallium-201 scintigraphy].

Evaluation of regional contractile reserve and the viability of an infarcted segment of the myocardium is very important in determining the indications for aorto-coronary bypass after myocardial infarction and in predicting the prognosis. Regional wall motion of the left ventricle after postextrasystolic potentiation (PESP) was studied in 18 patients with old myocardial infarction, and compared with indices of redistribution of thallium after exercise. Equilibrium radionuclide angiocardiography (RNA) using Tc99m HSA was performed at rest and after PESP produced by a programmable cardiac stimulator via a right ventricular catheter. Regional ejection fractions (REF) were determined, and wall motion was observed visually. The relative thallium activity (RTA) and washout rate (WOR) were obtained from exercise myocardial scintigraphy performed 10 minutes, and 3 hours after thallium-201 injections. Wall motion improved in 12 of 23 infarcted segments after PESP. Regional ejection fraction and relative thallium activity (in three hours, or the difference between the activities of the initial and three hours after exercise) in the improved segments were significantly higher (p less than 0.001) than in the unchanged segments. Washout rate was lower (p less than 0.02) in the improved segments. Significant correlation was observed between the change in regional ejection fraction and relative thallium activity (3 hours after exercise) (r = 0.654, p less than 0.05). Thus, the wall motion of some infarcted regions of the myocardium improved after PESP, and thallium was redistributed during three hours after exercise.(ABSTRACT TRUNCATED AT 250 WORDS)