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$60 Abstracts J O U R N A L OF N U C L E A R C A R D I O L O G Y

Tuesday morning, April 25, 1995 March/April 1995, Part 2

P09-237

Prognostic significance of septal defect on TI-201 sclntlgraphy In pts with left bundle branch block. Dominique Pavin, Danila Persico, Alberto Righetti Cardiology Center, University Hospital, Geneva, Switzerland

Left bundle branch block (LBB8) is sometimes associated with septal defect on thallium-201 scintigraphy (TI-201) in the absence of coronary disease (CAD) but its prognostic significance is unknown. 146 pts with permanent (n=132) or transient complete LBBB were separated according to the presence (G1, n=87) or absence (G2, n=59) of septal defect on planar TI-201. Pts with left anterior descending stenosis (LAD), previous anterior infarction or revascularisation of LAD were excluded. LBBB was associated with cardiac disease in 46 pts (53%) in G1 (systemic hypertension (SH),n=26 ; CAD,n=9; dilated cardiomyopathy (DM),n=9; 1 aortic regurgitatiom, 1 patent ductus arteriosus) and in 38 pts (64%) in G2 (SH,n=19; CAD,n=16, DC,n=3). After a mean follow-up of 87-+38mo in G1 and 81+41mo in G2, we observed the following cardiac events:

G1 (n=87) G2 (n=59) Septal defect No septal defect

Cardiac death (CD) 6 (7%) 4 (7%) Sudden death (SD) (%CD) 4 (67%) 1 (25%) High degre AV block 7 (8%) 3 (3%) Severe congestive failure 8 (9%) 4/7%) AV block + SD 10 (11%) ns 4 (7%) Cardiac events 15 (17%) ns 9 (15%)

These data suggest, that in patients with LBBB, the presence of septal defect on exercise TI-201 scintigraphy, unrelated to LAD disease, does not adversely affect the long term outcome in coml~adson to pts with LBBB but without septal defect.

P09-239

PREVALENCE AND CLINICAL IMPLICATION OF REVERSE REDISTRIBUTION OF THALLIUM-201 WITH STRESS/4-HOUR REINJECTION PROTOCOL.

Janusz Lipiecki, Jean Maublant, Jean-Michel Tarlet, Francois Cellier, Fr6d6ric Jousse, Danir Mestas , Bernard Citron, Annie Veyre, Jean Ponsonnaille. University Hospital, Clerrnont-Ferrand, F,

Although the oceurence of reverse redistribution (RR) is well documented at 4 hrs after a stress injection, its frequency and clinical implication are not clear when reinjection (reinj.) is performed. The SPECT images of a series of 577 consecutive patients (pts) who underwent a T1-201 stress/4-hr reinj, protocol were read twice. The incidence of RR was 9,7% (56 pts). A stress abnormality was observed in 91% of all pts and evidence for reversible ischemia in another territory than RR occured in 29%. RR appeared either at the periphery or at the same location than the stress abnormality in 78%. A remote myocardial infarction was present in 46% (26 pts) and RR was noticed in 65% of these territories. A follow-up of 135:6 months demonstrated a rate of cardiac events of 50% (28/56 pts), regardless of the presence or absence of reversible defects. It is concluded that (1) the frequency of RR with stressJ4-hr reinj, seems to be similar to that described at redistribution, (2) cardiac events are frequently present at follow-up in pts with RR.

P09-238

PROGNOSTIC UTILITY OF INCREASED PULMONARY THALLIUM UPTAKE IN PATIENTS WITHOUT ISCHEMIA N. Zafrir, S. T. Dahlberg, B.J. Villegas, J. A. Leppo, UMass, Worcester, USA; Beilinson Medical Center, Israel

Although the combination of increased pulmonary thallium uptake (IPTU) and ischemia has demonstrated prognostic utility, the value of IPTU independent of ischemia has not been critically evaluated. Accordingly, we studied two groups of patients (pts) with IPTU and either normal (NL, n = 48) or fixed defect (FD, n=44) scans and compared them to control (CON, n=92) pts without scan defects or IPTU. During a mean follow up of 23 • 13 months, there were 15 cardiac events (death or MI) and the incidence per year was 0.6%, 2% and 12% in the CON, NL and FD groups, respectively (p < 0.00001). Life table analysis demonstrated better event-free survival in the CON and NL groups compared to FD. When compared to the CON pts, those with IPTU and NL scans had a higher incidence of congestive failure and bypass surgery while those with IPTU and FD scans had increased LV cavity size and a higher proportion of male pts (p<0.002). A Cox

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regression analysis showed that the number of scar regions was the most important independent prog- nostic factor (p<O.O0001). We conciude that, in lots with IPTU and no stress perfusion defects, the prognosis is similar to CON pts. However, pts with multiple scars and IPTU have a significantly worse prognosis.

P09-240

EXERCISE RADIONUCLIDE CINEANGIOGRAPHY IN CORONARY ARTERY DISEASE: GENDER SPECIFIC PROGNOSTIC IMPLICATIONS P Supino, JS Borer, Comell Medical Center, New York, NY, USA

To determine whether exercise(ex) radionuclide cineangio- graphy(RNCA) predicts nonsurgieal(non-S) cardiac events (myocardial infarction or death) and total non-S or surgical events(TE) differently according to gender, we evaluated clinical course of 33 clinically stable women and 251 stable men with catheterization-proven 3-vessel CAD or prior CABG who were studied by exRNCA. During avg 8 yr followup, 4 women had MI, 2 had cardiac deaths, and 6 had CABG. Both non-S and TE events were more frequent in women whose EF fell severely with ex (AEF<-8%) than in those with z~F 0 to -7% or AF.F > 0% (p<.0005 [non- S], p<.0001 [TE]). While end-point rates were similar by gender, women with AEF_<<-8% were more likely to have non-S events (9<.02) and higher TE rates(p<.001) than comparably ischemic men. Thus prognostic implications of ischemia severity, though statistically valid for both groups alone, may differ according to gender. This fact may be important in interpreting the results of RNCA for management decision making.