Estimation of post-revascularization left ventricular ejection fraction an ischemic heart disease patients by using cavity to myocardial ratio of thallium reinjection image

Background: we reported the high correlation between cavity-to-myocardial [CM] count ratio at stress and rest thallium SPECT, and stress-rest ejection fraction [EF] calculated by MUGA test, this was confirmed by others. This correlation was explained partially by the functional mass. On the other hand, two important prognostic parameters should be considered before any revascularization technique: [1] Identification of viable myocardium and its amount, [2] Prediction of EF improvement post revascularization

Aim of the Study: correlating EF[C/M] on rest-redistribution [RD] and reinjection [RI] images [EF[RD]and EF[RI]] image to actual EF pre-revascularization [EF[1]] and 1-year post revascularization EF[2]

Patients and Methods: 78 patients with CAD [68 males and 10 females with mean age of 54.2 +/- 9 years] had been subjected to [1] Standard RD-RI thallium SPECT with assessment of reversible or fixed perfusion defects and calculation of CM and consequently the EFCM at the three settings. [2]Assessment of EF by MUGA at rest pre and 1-year post revascularization EF[1] and EF[2] respectively. These patients had been subjected to revascularization either by PTCA and stent [23/78 i.e. 29.5%] or by CABG [55/78, i.e. 70.5%]

Results: out of the 1560 myocardial segments [20 segments X 78 patients], 780 [50%] segments had abnormal resting wall motion. 441/780 [56.5%] of these segments were either of normal thallium uptake or with reversible perfusion defects while the rest [43.5%] showed fixed defects. 233/441 [52.8%] of those normal uptake or reversible segments showed recovery of wall motion post revascularization [PRV] while only 29/339 [15.1%] showed similar improvements. EFRI was found higher than EFRD in 44/78 of patients, no change in 23/78 patients and worsened in 11/78 patients with total agreements of 63/78 [80.8%] with EF2. On the other hand, EFRD was matched with EF1 in 64/78 of patients. 30/64 [46.9%] showed higher EF2, 23/64 [35.9%] showed similar EF2 while 11164 [17.2%] showed lower EF2. The rest of cases 14/78 showed mismatch between EFRD and EF1 with higher values of EFRD. These patients still had higher values of EFRI and EF2 than EFRD

Conclusion: [1] Mismatch between EFRD and EF1 is an indication of presence of stunning myocardium and of good prognosis. [2] EF[RI] can be used to predict EF2 and so helps on selecting patients who can benefit from revascularization

Efficacy and outcome of transmyocardial revascularization [TMR]: initial egyptian experience

In this study, 37 patients [with age 52 +/- 10.1, 31 males and 6 females] with severe coronary artery disease [CAD] and intractable angina were subjected to TMR. Nineteen patients had prior myocardial infarction [MI]. The mean angina class was 3.4 +/- 0.5. All patients were subjected to stress-redistribution reinjection [ST-RD-RI] Thallium SPECT protocol and rest 99 mTc-RBG MUGA just before, 3, 6, 9 and 12 months after TMR, aiming to assess the degree of change in perfusion in the ischemic area using semiquantitative score [I = normal and 4 = absent uptake] and to assess the function. The study concluded that TMR can be used effectively in cases of severe CAD, which could not be managed by either CABG or PTCA. Myocardial perfusion imaging is a good method to assess TMR results

Transmyocardial revascularization [TMR] versus medical treatment in patients with exensive coronary artery disease [12 months follow-up]

The aim of this study was to compare the efficacy of TMR versus medical management in cases of severe CAD not amenable to percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass grafting [CABG]. Sixty-six patients with severe CAD were treated randomly, either by TMR or medical treatment. Accordingly, they were divided into two groups: Group 1 included 26 patients who were treated medically, while group 2 included 40 patients who were treated by TMR. All patients were subjected to clinical assessment and stress-redistribution-reinjection [ST-KD-RI] Thallium SPECT protocol pre and post TMR [3, 6, 9 and 12 months]. The study concluded that TMR has been proved to be effective in the management of severe cases of CAD concerning the quality of life and survival. Transmyocardial revascularization is a treatment option for patients with medically refractory angina who are not candidates for conventional revascularization