The clinical impact of thallium-201 reinjection for the detection of myocardial hibernation

Thallium-201 reinjection improves detection of hibernating myocardium in about 30%-50% of persisting defects. The main goal of cardiac revascularization techniques is amelioration of clinical symptoms such as angina and dyspnoea; however, improvement in regional and global pump function is an additional and important target. The aim of this study was to investigate whether fill-in in the reinjection study is correlated with improved contractile function after treatment (percutaneous transluminal coronary angioplasty/aortocoronary bypass surgery). We studied 32 patients with coronary heart disease and impaired regional wall motion (RWM), RWM and ejection fraction (EF) were assessed by analysing ventriculographic images using the centreline method (values in standard deviations from mean values found in a healthy control group). Three Tl-201 single-photon emission tomographic studies (stress, redistribution and reinjection) were performed prior to revascularization and analysed using a bull's-eye scheme. Patients were divided into two groups (group FI-=no fill-in, n=16; group FI+=fill-in, n=16). Fifty-six percent of all patients showed persisting defects, and 56% of these defects showed fill-in after reinjection. Fill-in in our patient group was independent of the size of the persisting defects. After revascularization RWM increased significantly in group FI+ (from -1.9 to 0.0 SD, P<0.001) whereas group FI- showed no significant change (from -1.6 to -1.8 SD). EF increased from -4.3 preoperatively to -2.1 SD postoperatively in group FI+ and did not change significantly in group FI- (-2.5 to -3.2 SD). The predictive value of reinjection for improvement of RWM was 88%. It is concluded that fill-in in the Tl-201 reinjection image can predict recovery of RWM and EF after revascularization and should be used in all patients with impaired RWM and persisting defects independent of their extent.