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220 Contribution of the spect myocardial imaging in the detection of the viability of myocardium in the comment infarct before a gesture of revascularisation

By Nadia Diab

Abstract

A viable myocardium is able of functional recovering. The existence of a viability is thus an a posteriori observation, of a functional recovery after revascularisation. The aim of our study is to identify myocardial viability after post myocardial infarct with SPECT myocardial imaging in patients proposed for a revascularization procedure.This prospective study looked at patients who experienced previous infarct and in whom we performed a SPECT Thalium 201. The myocardial viability at SPECT was revealied by a residual ischaemia higher than 50% within a necrosed territory. The segmentar kinetics abnormalities were studied by echocardiography before revascularisation procedure then at 6 and 12 months after to estimate a recovery or at least an improvement of the kinetics after the procedure.The Segmentar kinetics study was made by qualitative analysis having allowing a codification of segments according 3 grades. We had 138 patients who benefit from revascularization procedure after detection of myocardial viability by SPECT in the territory of the MI (71 transluminale coronary angioplasty (TCA) and 67 aorto-coronary bypasses). We then confronted viable territories with the segmentar kinetics of these same territories at echocardiography, before and at the 6th and 12th month after the procedure.A functional recovery in term of improvement of the segmentar kinetics at the 6th or the 12th month is held as assessment criterion confirming the myocardial viability. 75% patients have improved their kinetics at 6 or 12 months The SPECT in the TL 201 allowed to detect a myocardial viability and thus to predict a functional recovery in post myocardial infarct period with a 96% sensitivity, a 80% specificity, a positive predictive value of 94% and a negative predictive value of 86%.The SPECT myocardial imaging is a good tool in the detection of the myocardial viability in the post myocardial infarct period

Publisher: Elsevier Masson SAS.
Year: 2011
DOI identifier: 10.1016/S1878-6480(11)70222-1
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