[Prognostic value of myocardial perfusion SPECT in multivessel coronary disease patients with left ventricular dysfunction, comparing revascularized and non-revascularized patients]. / Valor pronóstico del SPECT de perfusión miocárdica en pacientes coronarios con enfermedad multivaso y disfunción ventricular izquierda, comparando revascularizados y no revascularizados.

OBJECTIVE: We investigated the prognostic value of 99mTc-Tetrofosmin myocardial SPECT (99mTc-TF) in dysfunctional multivessel coronary disease patients who underwent revascularization (RV) or only medical treatment (MT). METHODS: In 78 coronary patients with 2-3 diseased vessels and left ventricular ejection fraction (EF) <= 40% (24 10%), we have assessed the extension of the stress perfusion defect, and percent of reversibility (R) by quantification of stress-rest myocardial SPECT 99mTc-TF bull's eyes (2 days-protocol), lung/heart ratio (LH) calculated in the original stress SPECT images, and EF by equilibrium radionuclide ventriculography obtained at 24 h. A R value >= 8% was used to identify viable (V) patients. A total of 28 patients underwent RV and 50 only received MT. After a mean follow-up of 22.9 20 months (3-60), they were considered as coronary events (CE): cardiac death, non-fatal infarction and heart transplant. CE rate was 20.5% (16/78). RESULTS: No significant differences were found in the pre-revascularization study characteristics, except a significantly higher mean R value in RV (10.6 9.5%) than in MT patients (6.4 7.8%) p: 0.03, and the main difference was that RV patients showed less CE 2/28 (7%) than the MT group 14/50 (28%) p: 0.02. The CE rate was lower in V patients who underwent RV (6%) than in V patients with MT (45%) p: 0.03, but no significant difference was obtained in non-V patients between RV (7%) and MT (16%) groups. In viable patients, the corresponding survival curves (Kaplan-Meier) showed a CE-free survival at 5 years of 79% in patients RV and of 42% in MT patients, p: 0.03, without significant difference in non-V patients. CONCLUSIONS: Patients with viable myocardium by myocardial SPECT have a good prognosis after revascularization, and show higher risk of CE if they are only medically treated. Myocardial viability is an indispensable assessment in prognosis evaluation and, above all, in therapeutic decision making in dysfunctional multivessel coronary disease patients.

Valor pronóstico del SPECT de perfusión miocárdica en pacientes coronarios con enfermedad multivaso y disfunción ventricular izquierda, comparando revascularizados y no revascularizados* / Prognostic value of myocardial perfusion spect in multivessel coronary disease patients with left ventricular dysfunction, comparing revascularized and non-revascularized patients

Objetivo: Investigamos el valor pronóstico del SPECT miocárdico con 99mTc-Tetrofosmin (99mTc-TF) en pacientes disfuncionales con coronariopatía multivaso, que sufrieron revascularización (RV) o fueron sometidos sólo a tratamiento médico (TM).Métodos: En 78 pacientes coronarios con 2-3 vasos afectos y fracción de eyección del ventrículo izquierdo (FE) 40 por ciento (24 ñ 10 por ciento) hemos valorado la extensión del defecto de perfusión de esfuerzo (E), el porcentaje de reversibilidad (R), mediante cuantificación del diagrama polar a partir del SPECT miocárdico de esfuerzo-reposo (protocolo 2 días), el índice pulmón/miocardio (P/M), calculado en las imágenes originales del SPECT de esfuerzo, y la FE, mediante ventriculografía isotópica de equilibrio, obtenida a las 24 h del SPECT. Se utilizó un valor de R 8 por ciento para identificar a los pacientes viables (V). Un total de 28 pacientes sufrieron RV (by-pass) y 50 recibieron sólo TM. Tras un seguimiento medio de 22,9 ñ 20 meses (3-60) se consideraron como accidentes cardíacos (AC): muerte cardíaca, trasplante cardíaco e IAM, que aparecieron en 16/78 (20,5 por ciento). Resultados: No se encontraron diferencias significativas en las características del estudio pre-revascularización, salvo una R media mayor en los RV (10,6 ñ 9,5 por ciento) que en los de TM (6,4 ñ 7,8 por ciento) p: 0,03, siendo lo principal la menor incidencia de AC en los RV, 2/28 (7,1 por ciento) que en los de TM, 14/50 (28 por ciento) p: 0,02. Hubo menor incidencia de AC en los pacientes V que fueron RV (6 por ciento) que en los pacientes V con TM (45 por ciento), p: 0,03, no siendo significativa la diferencia en los pacientes no V entre los RV (7 por ciento) y los de TM (16 por ciento). Se obtuvieron las correspondientes curvas de supervivencia (Kaplan-Meier), que mostraron, en los pacientes V, una probabilidad de supervivencia libre de AC a los 5 años del 79 por ciento en pacientes RV y del 42 por ciento en pacientes con TM, p: 0,03, sin ser significativas las diferencias en los pacientes no V. Conclusiones: Los pacientes con miocardio viable en el SPECT miocárdico, presentaron buen pronóstico tras revascularización y mostraron mayor riesgo de AC cuando recibieron sólo tratamiento médico. La detección de viabilidad miocárdica es una valoración indispensable en la evaluación pronóstica, y sobre todo en la toma de decisiones terapéuticas en los pacientes disfuncionales con coronariopatía multivaso (AU)

[Determination of ejection fraction and left ventricular fraction using isotopic ventriculography and bidimensional echocardiography. Comparison with contrast ventriculography]. / Determinación de la fracción de eyección y volúmenes del ventrículo izquierdo mediante ventriculografía isotópica y ecocardiografía bidimensional. Comparación con la ventriculografía de contraste.

OBJECTIVES: The aim of this study was to determine the correlation and agreement between the values of left ventricular ejection fraction and volumes assessed by echocardiography and radionuclide ventriculography with the results obtained by contrast angiography, as well as the variability of each method in these measurements. PATIENTS AND METHODS: In a group of 59 patients with a first acute myocardial infarction we have determined left ventricular ejection fraction and volumes by two-dimensional echocardiography, equilibrium radionuclide ventriculography and contrast angiography initially and six months after myocardial infarction. We also assess the variability in the determinations in these three methods. RESULTS: We found significant correlations in ejection fraction and volumes by radionuclide ventriculography and echocardiography with contrast angiography. The correlation was higher in ejection fraction and end-systolic volume by radionuclide ventriculography (r = 0.88 and r = 0.73) than by echocardiography (r = 0.55 and r = 0.63; p < 0.01), whereas the correlation of end-diastolic volume was moderate by both methods (r = 0.58 and r = 0.47), without significant differences. The agreement between contrast angiography and radionuclide ventriculography was higher, with narrower limits of agreement than between contrast angiography and echocardiography in ejection fraction as well as in ventricular volumes. We have found high and significant correlations between two determinations by each method in all parameters, although they were higher in ejection fraction by contrast angiography (r = 0.96) and radionuclide ventriculography (r = 0.98) than by echocardiography (r = 0.70; p < 0.01). The limits of agreement were always wider in echocardiography, narrower in contrast angiography and the narrowest in radionuclide ventriculography, showing its superior reproducibility. CONCLUSIONS: In this group of myocardial infarction patients, the variability in the measurements was lower by radionuclide ventriculography than by echocardiography, this could be the reason for overall better results found in correlation and agreement between radionuclide ventriculography and contrast angiography than between echocardiography and contrast angiography in the assessment of left ventricular ejection fraction and volumes.