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(Chest. 1995;107:335-340.)
© 1995 American College of Chest Physicians

Prospective Evaluation of Viable Myocardium by Quantitative Dipyridamole-Thallium-201 Scintigraphy and Radionuclide Ventriculography

Stuart W. Zarich MD1; Glen J. Kowalchuk MD1; Thomas Hill MD1; Edward J. Kosinski MD1; and Stanley M. Lewis MD1

1 From the Divisions of Cardiology and Nuclear Medicine, New England Deaconess Hospital, Harvard Medical School, Boston

Improvement of myocardial function is a major goal of coronary revascularization. Considerable interest remains in the preoperative identification of viable myocardium. We examined 26 consecutive patients with left ventricular dysfunction undergoing coronary artery bypass grafting. Serial dipyridamole-thallium imaging and radionuclide ventriculography was performed preoperatively and postoperatively. The relationship between preoperative and postoperative thallium perfusion and segmental wall motion was analyzed. The mean preoperative ejection fraction was 32 ± 9 (21 to 51%) and increased to 41 ± 12 (17 to 67%) postoperatively (p>0.01). Seventy-seven percent of patients improved their global ejection fraction postoperatively by >5%. Thallium perfusion improved postoperatively in 84% of reversible defects vs 63% of partially reversible defects and 35% of fixed defects. Segments with either reversible or partially reversible thallium defects showed an improved postoperative wall motion in 71% and 68%, respectively. Postoperative wall motion improved in 43% of fixed defects. Overall, 67% of hypokinetic segments showed improved postoperative wall motion while only 29% of akinetic or dyskinetic segments improved postoperatively. Preoperative thallium redistribution coupled with preserved wall motion was predictive of improvement in wall motion postoperatively and indirectly indicates myocardial viability. However, 43%, of fixed defects also showed improved postoperative wall motion. A significant improvement in global ejection fraction was found and could be predicted by a linear regression analysis utilizing clinical and thallium parameters.

Key Words: dipyridamole • revascularization • thallium imaging • radionuclide ventriculography

Submitted on October 4, 1993
Accepted on June 13, 1994




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[Abstract] [Full Text]


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Copyright © 1995 by the American College of Chest Physicians.