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

Background—An elevated Tl lung uptake after stress is related to an adverse prognosis. Methods and Results—The functional and prognostic significance of resting Tl lung uptake was assessed in 124 consecutive patients with ischemic heart disease and ejection fraction #35% undergoing rest-redistribution tomography to evaluate myocardial viability. Tl lung uptake significantly correlated with pulmonary wedge pressure (r50.66; P,0.01) and with a restrictive physiology by Doppler echocardiography (P,0.001). During a 13613-month follow-up, 13 patients died and 23 patients required hospitalization as the result of worsening heart failure or nonfatal myocardial infarction (cumulative events rate 29%). Patients with events had a significantly higher Tl lung/heart ratio (L/H) (P,0.001). A L/H value .0.61 best separated patients with and without events (ROC area under curve 0.82). Event-free survival was significantly lower in patients with L/H .0.61 (P,0.001); L/H .0.61 (x510.8; P,0.001) and a restrictive filling pattern (x53.6; P,0.05) were independent predictors of events. The prognostic value of L/H was incremental over that obtained by clinical, echographic and Doppler data (global x520.8). Conclusions—In patients with severe postischemic left ventricular dysfunction undergoing rest-redistribution Tl imaging, an increased lung tracer uptake showed incremental prognostic value over clinical and other imaging findings, providing clinically useful risk assessment. (Circulation. 2000;102:1795-1801.)