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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

View larger version (56K): [in a new window]   Figure 1 Diagram of the 13-segment model used for SPECT and echocardiography data analysis, showing the relation between each segment and the related coronary artery territory. Areas with vertical lines = left anterior descending artery; areas with horizontal lines = left circumflex artery; open areas = right coronary artery.

View larger version (60K): [in a new window]   Figure 2 Diagram of the coronary artery tree (upper panel) and myocardial perfusion polar map displays (lower panel) of a patient with three-vessel CAD (coronary artery jeopardy score = 10) and severe LV dysfunction (NYHA functional class 2, LVEF 20%). On the baseline study, large moderate uptake defects are observed in the anterior and inferior wall, with clear increase in sestamibi activity on the nitrate study. The patient was refused by the surgeon for technical difficulties in performing CABG and for the high risk associated with the procedure. Therefore, the patient underwent successful PTCA on LCX (left circumflex artery), and on RCA (right coronary artery), whereas the LAD (left anterior descending) could not be treated. The patient had regional and global functional recovery (LVEF 40%), with disappearance of effort dyspnea, but died because of sudden death seven months after PTCA.

View larger version (20K): [in a new window]   Figure 3 Kaplan-Meier survival curves of the three patient groups identified according to treatment (see text).

View larger version (20K): [in a new window]   Figure 4 Kaplan-Meier survival curves of the three patient groups identified according to the number of viable asynergic segments not submitted to revascularization.