[Assessment of myocardial viability using 201TL SPECT at rest to predict the reversibility of left ventricular wall motion abnormalities].

AIM

The aim of the present study was to predict preoperatively the reversibility of left ventricular wall motion abnormalities using TI-201 SPECT at rest.

METHODS

19 patients with advanced coronary artery disease and regional wall motion abnormalities were examined at rest with TI 201 SPECT (acquisition 15 minutes and 3 hours post injection). Successfully revascularized, proven by a second coronary angiography three month after revascularisation. Wall motion was again evaluated by cineventriculography.

RESULTS

The preoperative a- or dyskinetic segments were best separated by the minimal relative TI-201 uptake in the defect 3 hrs p.i. in (i) postinterventionally improved wall motion (TI-201 uptake 67 +/- 14%, viable) and in (ii) without recovery (TI-201 uptake 46 +/- 12%, p < 0.001, non viable). A threshold at a TI-201 uptake of more than 50% yielded a positive predictive value of 0.73 and a negative predictive value of 0.86. If the segments with wall motion abnormalities (hypokinetic included) were evaluated as one group, no such threshold was obtained all segments which occurred a TI-201 uptake of more than 80% showed a functional recovery, wall motion did not improve in any segment with a TI-201 uptake of less than 40%. In the present study a considerable influence of the defect localisation with regard to the posterior wall was not observed. The values of TI-201 redistribution under resting condition were not useful to predict functional recovery.

CONCLUSION

TI-201 SPECT in rest predicts preoperatively the reversibility in regions with severe wall motion abnormalities only and indicates myocardial viability in these cases. Thus, the method is basically useful to determine myocardial viability. In hypokinetic segments, however, a wide range of TL-201 uptake values exists without definite evidence to functional recovery.