Author + information
- Received December 2, 1994
- Revision received April 25, 1995
- Accepted May 3, 1995
- Published online October 1, 1995.
- Pierre-Yves Marie, MDa,b,c,*,
- Nicolas Danchin, MD, FACCa,b,c,
- Jean F. Durand, MDa,b,c,
- Luc Feldmann, MDa,b,c,
- Alain Grentzinger, MDa,b,c,
- Pierre Olivier, MDa,b,c,
- Gilles Karcher, MDa,b,c,
- Yves Juilliére, MDa,b,c,
- Jean M. Virion, MSca,b,c,
- Daniel Beurrier, MDa,b,c,
- François Cherrier, MDa,b,c and
- Alain Bertrand, MDa,b,c
- ↵*Address for correspondence: Dr. Pierre-Yves Marie, Service de Médecine Nucléaire, CHU Nancy-Brabois, 54511 Vandoeuvre Cedex. France.
Objectives. This study sought to evaluate the prognostic role of exercise thallium-201 (T1-201) single-photon emission computed tomography (SPECT) in patients with known or suspected coronary artery disease.
Background. Compared with planar Tl-201 scintigraphy, Tl-201 SPECT allows enhanced assessment of myocardial perfusion abnormalities. However, the long-term prognostic value of exercise Tl-201 SPECT has not been ascertained and compared with that of other techniques of investigation.
Methods. Predictors of ischemic events were sought in 217 patients with known or suspected coronary artery disease who underwent exercise Tl-201 SPECT, coronary angiography and rest radionuclide angiography and who initially received medical therapy. Predictive values were determined using Cox proportional hazards regression models.
Results. During a mean (±SD) follow-up period of 70 ± 19 months, 29 patients had a major ischemic event (cardiac death or myocardial infarction). Total extent of exercise defects was the best independent predictor by Tl-201 SPECT of major events (p < 0.001) and provided additional prognostic information compared with clinical, exercise testing and catheterization variables (p < 0.02). Extent of reversible Tl-201 SPECT perfusion defects provided additional prognostic information compared with extent of irreversible defects (p < 0.001) and was the sole Tl-201 SPECT variable providing additional prognostic information compared with radionuclide left ventricular ejection fraction (p < 0.02).
Conclusions. Total extent of exercise Tl-201 SPECT defects is a powerful long-term predictor of major ischemic events that enhances the prediction provided by clinical, exercise testing and coronary angiographic data. In view of its prognostic significance, extent of reversible Tl-201 SPECT defects might provide original information about improving prognosis by coronary revascularization.
This investigation was supported by Projet Hospitalier de Recherche Clinique 1994-A from the Hospital of Nancy, Nancy, France.
- Received December 2, 1994.
- Revision received April 25, 1995.
- Accepted May 3, 1995.
- American College of Cardiology