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VOLUME 3 , ISSUE 1--2 ( January-June, 2024 ) > List of Articles


A 3-year Follow-up and Management of Patients with Stable Chronic Coronary Artery Disease: Is There a Role of Reverse Redistribution in Better Prognosis?

Ivan Jurić, Emir Fazlibegović, Anshul Saxena

Keywords : Angioplasty, Coronary artery disease, Collateral circulation, Left ventricular ejection fraction, Thallium scintigraphy

Citation Information : Jurić I, Fazlibegović E, Saxena A. A 3-year Follow-up and Management of Patients with Stable Chronic Coronary Artery Disease: Is There a Role of Reverse Redistribution in Better Prognosis?. 2024; 3 (1--2):46-52.

DOI: 10.5005/jp-journals-11005-0066

License: CC BY-NC 4.0

Published Online: 27-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Reverse redistribution of thallium-201 (201TI) imaged through scintigraphy can be helpful in assessing the myocardial viability among patients with stable coronary artery disease (CAD). Knowledge about reverse redistribution and its association with long-term cardiac outcomes is limited. Materials and methods: Adult patients with stable CAD were eligible for inclusion. Patients underwent exercise-redistribution thallium single-photon emission computed tomography (SPECT) and were followed up for 3 years. Patients were assessed by echocardiography for left ventricular ejection fraction (LVEF) and regional wall motion abnormalities, bicycle testing for exercise duration, and thallium SPECT for myocardial ischemia and viability. Results: A total of 156 patients with well-developed collaterals were studied. At the 3-year follow-up, patients showing reverse redistribution depicted significantly improved exercise tolerance (≥85%; p < 0.001); improved LVEF (p < 0.001); less myocardial necrosis (p < 0.05); wall motion parameters (p < 0.001); fewer angina episodes during follow-up (p = 0.02), and fewer ischemic events irrespective of being treated with oral medial therapy or percutaneous coronary intervention (PCI) (p < 0.001). Conclusion: Findings suggest that adequately treated chronic CAD patients with reverse redistribution may show a better prognosis with less likelihood of adverse cardiovascular events after 3 years.

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  1. Authors/Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35(37):2541–2619. DOI: 10.1093/eurheartj/ehu278
  2. Morrow DA, Gersh BJ, Braunwald E. Chronic coronary artery disease. Braunwald's Heart Disease: A Textbook Of Cardiovascular Medicine, 8th edition. Elsevier Saunders; 2008. pp. 1353–1417.
  3. Katritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation 2005;111(22):2906–2912. DOI: 10.1161/CIRCULATIONAHA.104.521864
  4. Linden B. Guidelines on the management of stable coronary artery disease. Br J Card Nurs 2013;8(11):519–520. DOI: 10.12968/bjca.2013.8.11.519
  5. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356(15):1503–1516. DOI: 10.1056/NEJMoa070829
  6. Antoniucci D, Valenti R, Moschi G, et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol 2002;89(2):121–125. DOI: 10.1016/s0002-9149(01)02186-5
  7. Jurić I, Fazlibegović E, Pravdić D, et al. The significance of thallium-201-chloride SPECT myocardial perfusion imaging in the management of patients with stable chronic coronary artery disease. Clin Med Insights Cardiol 2018;12:1179546818790562. DOI: 10.1177/1179546818790562
  8. Popma JJ. Percutaneous coronary and valvular intervention. Heart Disease: A Textbook of Cardiovascular Medicine. 2005. pp. 1377–1380.
  9. Selwyn AP, Braunwald E. Ischemic heart disease. Harrison's Principles of Internal Medicine. 1998. pp. 1365–1374.
  10. Tanesecu D. Apparent worsening of thallium-201 myocardial defects during redistribution - what does it mean? J Nucl Med 1979;20:688.
  11. van Royen N, Piek JJ, Schaper W, et al. A critical review of clinical arteriogenesis research. J Am Coll Cardiol 2009;55(1):17–25. DOI: 10.1016/j.jacc.2009.06.058
  12. Pace L, Perrone-Filardi P, Mainenti PP, et al. Effects of myocardial revascularization on regional thallium-201 uptake and systolic function in regions with reverse redistribution on tomographic thallium-201 imaging at rest in patients with chronic coronary artery disease. J Nucl Cardiol 1998;5(2):153–160. DOI: 10.1016/s1071-3581(98)90198-2
  13. Shi H, Zhang X, Huang R, et al. Evaluation of therapeutic responses after stem cell implanted using thallium-201 myocardial perfusion imaging: reverse redistribution is a sign of good response? J Nuclear Med 2007;48(supplement 2):3P–3P.
  14. Seiler C, Billinger M, Fleisch M, et al. Washout collaterometry: a new method of assessing collaterals using angiographic contrast clearance during coronary occlusion. Heart 2001;86(5):540–546. DOI: 10.1136/heart.86.5.540
  15. Mukherjee D. Coronary revascularization in the United States-patient characteristics and outcomes in 2020. JAMA Netw Open 2020;3(2):e1921322. DOI: 10.1001/jamanetworkopen.2019.21322
  16. Alkhouli M, Alqahtani F, Kalra A, et al. Trends in characteristics and outcomes of patients undergoing coronary revascularization in the United States, 2003-2016. JAMA Netw Open 2020;3(2):e1921326. DOI: 10.1001/jamanetworkopen.2019.21326
  17. Hochman JS, Reynolds HR, Bangalore S, et al. Baseline characteristics and risk profiles of participants in the ISCHEMIA randomized clinical trial. JAMA Cardiol 2019;4(3):273–286. DOI: 10.1001/jamacardio.2019.0014
  18. Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996;334(26):1703–1708. DOI: 10.1056/NEJM199606273342604
  19. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007;49(21):2105–2111. DOI: 10.1016/j.jacc.2007.01.087
  20. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360(3):213–224. DOI: 10.1056/NEJMoa0807611
  21. Pfisterer M. Long-term outcome in elderly patients with chronic angina managed invasively versus by optimized medical therapy: four-year follow-up of the randomized Trial of Invasive Versus Medical Therapy in Elderly Patients (TIME). Circulation 2004;110(10):1213–1218. DOI: 10.1161/01.CIR.0000140983.69571.BA
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