Long-term prognostic value of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular dysfunction and coronary artery bypass surgery

Objectives: This study sought to evaluate the long-term prognostic significance of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular (LV) dysfunction and coronary artery bypass surgery. Background: Preoperative stress-redistribution-reinjection TI-201 imaging detects viable but asynergic segments which show functional improvement postoperatively and is considered as a valuable noninvasive method in selection of patients with severe LV dysfunction for revascularization. The long-term prognostic value of the reinjection technique remains unclear. Methods: Fifty-two patients with severe LV dysfunction (mean ejection fraction (EF) 0.32 +/- 0.03) who underwent coronary artery bypass surgery in 1993-1994 were included in the study. Patients had follow-up 49 :1: 12 months. LV function was assessed by two-dimensional echocardiography. Perfusion was assessed by TI-201 SPECT imaging and was graded on a four-point scale (0 = normal, 3 = absent uptake) using the 20 segment model. Perfusion index was derived by adding the score of all segments and dividing these by 20. Patients were divided into two groups. Group A comprised patients with seven and more dysfunctional viable myocardial segments. Group B included patients with less than seven dysfunctional but viable segments. Results: Mean EF increased from 0.32 +/- 0.03 to 0.46 +/- 0.04. Mean perfusion index did not show a significant difference as a whole during follow-up compared to the early postoperative values (0.9 +/- 0.4 and 1.1 +/- 0.4, p = NS). When adequacy of revascularization was considered, the predictive value of a positive preoperative viability test for functional improvement was 82%. Nineteen cardiac events occurred in group B patients and six in group A patients: six deaths (four from cardiac and two from noncardiac causes), 13 myocardial infarctions (MI). Multivariate Cox survival analysis identified the number of viable segments detected preoperatively (chi(2) = 7.2, p = 0.002), postoperative improvement in Tl-uptake (chi(2) = 6.6, p = 0.01) and functional improvement (chi(2) = 5.3, p = 0.03) postoperatively as independent predictors of cardiac events. Preoperative EF and functional capacity were not associated with cardiac events in long-term prognosis. Conclusion: These data suggest that preoperative stress-redistribution-reinjection TI-201 imaging, specifically the number of viable segments detected preoperatively and postoperative improvement in TI-201 uptake provide important long-term prognostic information in patients with severe LV dysfunction who had coronary artery bypass surgery.

Yazar Gursurer, M
Emre, AE
Gercekoglu, H
Uslubas, S
Aksoy, M
Ersek, B
Yayın Türü Article
Tek Biçim Adres https://hdl.handle.net/20.500.12628/2897
Tek Biçim Adres 10.1023/A:1014654822287
Konu Başlıkları left ventricular dysfunction
prognosis
radionuclide imaging
revascularization
viability
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
PubMed İndeksli Yayınlar Koleksiyonu
WoS İndeksli Yayınlar Koleksiyonu
Dergi Adı INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
Dergi Cilt Bilgisi 18
Dergi Sayısı 2
Sayfalar 125 - 133
Yayın Yılı 2002
Eser Adı
[dc.title]
Long-term prognostic value of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular dysfunction and coronary artery bypass surgery
Yazar
[dc.contributor.author]
Gursurer, M
Yazar
[dc.contributor.author]
Emre, AE
Yazar
[dc.contributor.author]
Gercekoglu, H
Yazar
[dc.contributor.author]
Uslubas, S
Yazar
[dc.contributor.author]
Aksoy, M
Yazar
[dc.contributor.author]
Ersek, B
Yayın Yılı
[dc.date.issued]
2002
Yayıncı
[dc.publisher]
SPRINGER
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Objectives: This study sought to evaluate the long-term prognostic significance of stress-redistribution-reinjection Tl-201 imaging in patients with severe left ventricular (LV) dysfunction and coronary artery bypass surgery. Background: Preoperative stress-redistribution-reinjection TI-201 imaging detects viable but asynergic segments which show functional improvement postoperatively and is considered as a valuable noninvasive method in selection of patients with severe LV dysfunction for revascularization. The long-term prognostic value of the reinjection technique remains unclear. Methods: Fifty-two patients with severe LV dysfunction (mean ejection fraction (EF) 0.32 +/- 0.03) who underwent coronary artery bypass surgery in 1993-1994 were included in the study. Patients had follow-up 49 :1: 12 months. LV function was assessed by two-dimensional echocardiography. Perfusion was assessed by TI-201 SPECT imaging and was graded on a four-point scale (0 = normal, 3 = absent uptake) using the 20 segment model. Perfusion index was derived by adding the score of all segments and dividing these by 20. Patients were divided into two groups. Group A comprised patients with seven and more dysfunctional viable myocardial segments. Group B included patients with less than seven dysfunctional but viable segments. Results: Mean EF increased from 0.32 +/- 0.03 to 0.46 +/- 0.04. Mean perfusion index did not show a significant difference as a whole during follow-up compared to the early postoperative values (0.9 +/- 0.4 and 1.1 +/- 0.4, p = NS). When adequacy of revascularization was considered, the predictive value of a positive preoperative viability test for functional improvement was 82%. Nineteen cardiac events occurred in group B patients and six in group A patients: six deaths (four from cardiac and two from noncardiac causes), 13 myocardial infarctions (MI). Multivariate Cox survival analysis identified the number of viable segments detected preoperatively (chi(2) = 7.2, p = 0.002), postoperative improvement in Tl-uptake (chi(2) = 6.6, p = 0.01) and functional improvement (chi(2) = 5.3, p = 0.03) postoperatively as independent predictors of cardiac events. Preoperative EF and functional capacity were not associated with cardiac events in long-term prognosis. Conclusion: These data suggest that preoperative stress-redistribution-reinjection TI-201 imaging, specifically the number of viable segments detected preoperatively and postoperative improvement in TI-201 uptake provide important long-term prognostic information in patients with severe LV dysfunction who had coronary artery bypass surgery.
Açıklama
[dc.description]
WOS: 000176545900007
Açıklama
[dc.description]
PubMed: 12108908
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
eng
Konu Başlıkları
[dc.subject]
left ventricular dysfunction
Konu Başlıkları
[dc.subject]
prognosis
Konu Başlıkları
[dc.subject]
radionuclide imaging
Konu Başlıkları
[dc.subject]
revascularization
Konu Başlıkları
[dc.subject]
viability
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
ISSN
[dc.identifier.issn]
1569-5794
ISSN
[dc.identifier.issn]
1573-0743
İlk Sayfa Sayısı
[dc.identifier.startpage]
125
Son Sayfa Sayısı
[dc.identifier.endpage]
133
Dergi Adı
[dc.relation.journal]
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
Dergi Sayısı
[dc.identifier.issue]
2
Dergi Cilt Bilgisi
[dc.identifier.volume]
18
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.1023/A:1014654822287
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/2897
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
10
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
06 Şubat 2024 23:30
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Tıklayınız
patients segments improvement viable imaging severe dysfunction cardiac functional long-term TI-201 (chi(2) events prognostic postoperative artery bypass coronary surgery stress-redistribution-reinjection included Patients follow-up assessed myocardial Perfusion dysfunctional preoperative postoperatively considered Preoperative revascularization number preoperatively detected
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