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CLINICAL STUDY

Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction

Roberto Sciagrà, MD^a, Marco Pellegri, MD^a, Alberto Pupi, MD^a, Leonardo Bolognese, MD^*, Gianni Bisi, MD, Vito Carnovale, MD^a* and Giovanni M. Santoro, MD^*

^a Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
^* Division of Cardiology, Careggi Hospital, Florence, Italy
Nuclear Medicine, University of Turin, Turin, Italy

Manuscript received October 21, 1999; revised manuscript received March 15, 2000, accepted April 26, 2000.

Reprint requests and correspondence: Dr. Roberto Sciagrà, Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
r.sciagra{at}dfc.unifi.it

OBJECTIVES

The aim of the study was to verify the prognostic implications of viability detection using baseline-nitrate sestamibi imaging in patients with left ventricular (LV) dysfunction due to chronic coronary artery disease (CAD) submitted to different therapeutic strategies.

BACKGROUND

The prognostic meaning of preserved viability in these patients is still debated. Sestamibi is increasingly used for myocardial perfusion scintigraphy and is being accepted also as viability tracer, but no data are available about the relationship between viability in sestamibi imaging, subsequent treatment, and patient’s outcome.

METHODS

Follow-up data were collected in 105 CAD patients with LV dysfunction who had undergone baseline-nitrate sestamibi perfusion imaging for viability assessment and had been later treated medically (group 1), or submitted to revascularization, which was either complete (group 2A) or incomplete (group 2B).

RESULTS

Eighteen hard events (cardiac death or nonfatal myocardial infarction) were registered during the follow-up. A significantly worse event-free survival curve was observed in the patients of group 1 (p < 0.0002) and group 2B (p < 0.03) compared to those of group 2A. Using a Cox proportional hazard model, the most powerful prognostic predictors of events were the number of nonrevascularized asynergic segments with viability in sestamibi imaging (p < 0.003, risk ratio [RR] = 1.4), and the severity of CAD (p < 0.02, RR = 1.28).

CONCLUSIONS

Viability detection in sestamibi imaging has important prognostic implications in CAD patients with LV dysfunction. Patients with preserved viability kept on medical therapy or submitted to incomplete revascularization represent high-risk groups.

Abbreviations and Acronyms   ANOVA = analysis of variance   CABG = coronary artery bypass grafting   CAD = coronary artery disease   CCS = Canadian Cardiovascular Society   CI = confidence interval   EF = ejection fraction   LV = left ventricular   NYHA = New York Heart Association   PTCA = percutaneous transluminal coronary angioplasty   RR = risk ratio   SPECT = single-photon emission computed tomography

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