Abstract
Objective: The reverse redistribution (RR) phenomenon is not infrequently observed during performance of stress/rest Tl-201 myocardial perfusion studies. In patients with a positive medical history (e.g., of myocardial infarction), the prognostic value of RR defect can be high. However, most patients with RR defects do not have high risk profiles, and determining whether these patients should have a coronary angiogram often poses a clinical dilemma. The purpose of this study was to determine whether regional wall motion abnormality improves the prognostic value of RR in Tl-201 myocardial perfusion evaluation. Materials and Methods: In this study, data from patients with RR defects on a myocardial perfusion study who subsequently underwent coronary angiography within one month (n=36) were analyzed and compared. Results: We found that regional wall motion abnormality on ECG-gated SPECT imaging coexisting in the same segment with an RR defect improved the ability of myocardial infusion to detect coronary stenosis. By comparing this combination of myocardial infusion findings with coronary angiographic findings (the gold standard results), we found that the total accuracy rate, positive predictive value, and negative predictive value of the myocardial perfusion study were 72.2% (26/36), 71.4% (15/21), and 73.3% (11/15), respectively. Conclusions: Regional wall motion abnormalities in conjunction with RR indicate a high probability of significant coronary stenosis and patients with these abnormalities should undergo coronary angiography. However, RR without wall motion abnormalities generally indicates a low probability of significant coronary artery stenosis.
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