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S 106 Abstracts Journal of Nuclear Cardiology Wednesday afternoon, April 9, 1997 January/February 1997, Part 2

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PROGNOSTIC VALUE OF ABNORMAL MYOCARDIAL SPECT IN DIABETICS WITH NORMAL EPICARDIAL CORONARY ARTERIES D Groat, Y America, ZX He, JJ Mahmarian, MS Verani. Baylor College of Medicine, Houston, TX, USA

We evaluated the prognostic value of stress myocardial SPECT in diabetic patients (pts) with angiographically normal coronary arteries. Thirty-nine such pts (21 males, 18 females, mean age 58+12 years) were included. Pts with previous coronary bypass surgery or angioplasty were excluded. Fourteen pts had a normal stress SPECT, whereas 25 pts had an abnormal SPECT study. Among the latter, perfusion defects were totally reversible in 14, partially reversible in 5 and persistent in 6 pts. The defect size (% LV) measured 16-+8%. Thirty-five pts were followed-up for a mean period of 25+18 months, and 4 were lost to follow-up. A total of 10 cardiac events were observed: cardiac death (n=2), nonfatal myocardial infarction (n=2), heart failure (n=3) and unstable angina (11=3). The cardiac event rate was 39% (9/23) in pts with an abnormal SPECT, compared to 8% (1/12) in pts with a normal SPECT (p=0.05). Thus, despite having normal epicardial coronary arteries, diabetic pts with an abnormal stress SPECT study are at increased risk for cardiac events.

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Exercise Technetium 99m Sestamibi SPECT after Coronary Artery Bypass Surgery. A.Desideri,G. Candelpergher, P.Zanco,G. Suzzi,N.Borsato, G.Fedin oL.Celegon. S.Giacomo Hospital, Castelfranco Veneto (TV), Italy

We assessed the prognostic in_formation obtained with exercise sestamibi SPECT scintigraphy performed for routinary follow up or reappearance of symptoms atter Coronary Artery Bypass Surgery (CABG). We studied 75 patients (pts) referred to our Center at a mean of 38+-53 months from the revascularization procedure and prospectively followed them for 38+-24 months. Fifteen pts (20%) had events(CE) : there were 4 cardiac deaths, 3 nonfatal AMI, 8 late revasculafization procedures (4 PTCA and 4 repeat CABG). Univariate analysis identified a history of typical angina (p=0.001), a clinically positive ergometric test (p=0.009), peak exercise heart rate (p=0.0003) and scintigraphie summed reversibility score (p=0.014) as predictors of CE. Using multivariate logistic regression analysis, the best and only significant predictor of CE was the summed reversibility score (p=0.008).We conclude that exercise sestamibi SPECT scintigraphy provides optimal prognostic information after clinical and ergometric parameters in patients with previous CABG.

95.4

Transient lschemic Dilation Identifies Risk of Subsequent Cardiac Events TJ Fisher, RG Schwartz, C Thompson, T van Geel, J Carleo, J Leon. University of Rochester, Rochester, NY

Transient ischemic dilation (TID) by SPECT myocardial perfusion imaging (MPI) accurately identifies severe and extensive coronary artery disease (CAD), and limited data suggest its prognostic utility. To evaluate further its prognostic value, we compared cardiac death + nonfatal MI (HARD), and revascularization (CABG, PTCA) events for > 1 year after MPI in t54 patients (pts) with TID and in case matched controls (CMC) with abnormal scans but no TID studied between 7/1/93 and 6/30/95.

MPI N= HARD CABG PTCA TID 154 15 (9.7%) 45 (29%) 15 (10%)

CMC 154 7(4.5%) 12 (7.8 %) 7(4.5%) WNL 331 2 (0.6%) 5 (1.5%) 5 (1.5%)

Compared to CMC, pts with TID had higher mean LV volume ratios by quantitative 3-D wall parameterization method (1.21 +/- 0.14 vs. 1.10 +/- 0.13, P<0.001), and more frequent cardiac events (P<0.001, McNemar's test), despite similar LVEF (45 +/- 17% vs. 44 +/- 18%) and exercise duration. We conclude TID by SPECT MPI identifies risk of morbid isehemic events.

96.1 PREDICTION OF POST-REVASCULARIZATION FUNCTIONAL RECOVERY WITH SIMULTANEOUS, COMI]INED DOBUTAMINE ECHOCARDIOGRAPHY AND PERFUSION IMAGING l.Vassiliadis, A.Fountos,A. Papademetriou,K.Dimas,l.Kallikazaros, E. Sbortias, P. Strembelas,A. Koroneos.Athens Naval Hospital,Athinai, Greece

Thallium Perfusion Imaging with reinjection (SPECT-R) and Dobutamine Stress Echocardiography (DSE) are currently applied to identify myocardial viability. We compared these two methods in their ability to detect post-infarction viability and their accuracy to predict post-revaseularization recovery. Thirty pts with prior myocardial infarction and impaired left vcntricular funetinn were assessed with simultaneous,combined SPECT-R and DSE. Sixteen pts were allocated Io receive interventional treatment

(PTCA = 9,CABG = 7) based on viability criteria:wall motion improvement/worsening of systolic thickenning by DSE and thallium re-uptake of more than 5007o by SPECT-R. Of the 150 segments with persistent defect,58(37~0) demonstrated re-uptake. A positive response to Dobulamine infusion was detected in 48(83%) of the 58 segments by DSE. Dobulamine had no effect in 46(49°70) of the 94 segments,

characterized by thallium-as non-viable. O f the 44 snccesfuUy reperfused segments,IS(41%) demonstrated functional recovery on the follow-up study.The prediction of reversible isehemic dysfunction by SPECT-R and DSE demonstrated respectively and sensitivity of 93070 vs7807e,specificity of 7707o vs 86070 and predictive accuracy of 86% vs 60%. A moderate agreement (K = 0.52) was achieved by the two

methods, assessing the concordant results on viability, while a better correlation (r =- 0.75) was found in the prediction of segments demonslrating post-revascularization recovery . Our data suggest that SPECT-R and DSE exeibiled a satisfactory degree of sensitivity in predicting the revascularization outcome of the hibernating myocardium. SPEC"r-R appears to be more accurate in assessing the extent of viability.