451. The role of 99mTc-tetrofosmin myocardial perfusion imaging in risk stratifying patients with prior myocardial infarction and advanced left ventricular dysfunction
- Author
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Itsuro, Morishima, Takahito, Sone, Hideyuki, Tsuboi, Hiroaki, Mukawa, Masahiko, Satoda, Michitaka, Uesugi, Yasuhiro, Morita, Eijiro, Hayashi, and Kensuke, Takagi
- Abstract
Background:MADIT-II has shown that the prophylactic ICD improves survival of patients with prior myocardial infarction and advanced LV dysfunction; identifying subgroups at greater risk may lead to directing therapy to specific patients who may benefit most. Methods:To determine whether 99mTc-tetrofosmin myocardial perfusion SPECT (TF-SPECT) risk stratify for arrhythmic death, 82 patients who met the MADIT-II criteria (LVEF by QGS =0.3; myocardial infarction a month ago; no sustained ventricular tachyarrhythmia) were screened out of 3,746 consecutive patients who had undergone rest TF-SPECT. The SPECT images of these 82 were analyzed by QGS and AutoQUANT software; their clinical courses were reviewed.Results:The patients were male(79%), 69 ± 10 years, and LVEF 25 ± 5%. During an average follow-up of 24 months, arrhythmic death occurred in 10 patients. The defect volume by AutoQUANT, which represents infarct volume, was significantly larger in patients with arrhythmic death than in other patients (57 ± 19 vs. 44 ± 25ml, p=0.03), which suggests that the patients with arrhythmic death had greater arrhythmogenic substrate than did the other patients. Kaplan-Meier survival analysis demonstrated that the arrhythmic event-free survival was significantly worse in patients with defect volume /=45ml (median of these 82 patients) than those with defect volume < 45ml (p=0.013). Conclusion:Large defect volume in TF-SPECT may indicate being at high risk for arrhythmic death in the MADIT-II population.
- Published
- 2004
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