Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

Abstract

In patients with severe postischemic left ventricular dysfunction undergoing rest-redistribution (201)Tl imaging, an increased lung tracer uptake showed incremental prognostic value over clinical and other imaging findings, providing clinically useful risk assessment.

Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization

“…Given the modest correlations and the rapid washout of 99m Tc, the reporting of LHR with stress 99m Tc is not a common practice. LHR with resting 201 Tl appears to be somewhat inferior to LHR with stress 99m Tc but, more importantly, it has never been validated in a group of patients with preserved left ventricular systolic function (8,10,23).…”

“…With the transition from 201 Tl to 99m Tc, access to stress 201 Tl lung uptake data is no longer available. With the loss of stress 201 Tl LHR data, few studies have assessed the utility of stress 99m Tc and resting 201 Tl lung uptake for predicting left ventricular filling pressure (8)(9)(10)23).…”

“…Marcassa et al (23) investigated the use of resting 201 Tl LHR, which is quite often used with 99m Tc in dual-isotope imaging. In a group of 159 consecutive patients with LVEFs of #35% (mean 6 1 SD, 23% 6 6%), resting 201 Tl LHR had significant predictive power for subsequent cardiac events and mortality.…”

Clinical Significance of Tetrofosm in Extracardiac Uptake During Myocardial Perfusion Imaging

“…Follow-up studies have shown that abnormal lung Tl-201 uptake is in general a significant predictor of subsequent adverse cardiac events for patients undergoing an MPI. Moreover, the Tl-201 LHR prognostic value has been reported in specific subgroups such as in patients treated with thrombolytic therapy during acute myocardial infarction, in patients with unstable angina and non-Q myocardial infarction, in patients after coronary artery bypass grafting, in patients with left ventricular apical aneurysm and in patients with severe postischaemic left ventricular dysfunction or after heart transplantation (Dakik et al, 1996;Jain et al, 1997;Krawczynska et al, 1997;Marcassa et al, 2000;Sarda et al, 2001;Wu et al, 2005). Abnormal pulmonary Tl-201 uptake during stress (treadmill or pharmacologic test) imaging has similar clinical significance to that noted during exercise.…”

“…Thus, high uptake of Tl-201 in the lungs has an important prognostic value (Brown, 1997;Chin et al, 1996;Daou et al, 2000;Gill et al, 1987;Morel et al, 1999). Moreover, published data present an incremental prognostic value of increased Tl-201 pulmonary uptake over clinical, stress testing and other imaging findings, providing clinically useful risk assessment (Marcassa et al, 2000).…”