Will the myocardial tomo-scintigraphies with Tl-201 allow predicting the ventricular remodeling ensuing after the angioplasty of an artery responsible of an infarction?

The coronary transluminal angioplasty (CTA) of the artery responsible of an infarction is susceptible of limiting the left ventricular remodeling. However, the influence of the residual myocardial viability on the remodeling was never analyzed. We have included 64 patients which have had in-effort thallium-201 tomo-scintigraphies with at-rest reinjection (MTS) having a CTA in the territory of a recent infarction (26 ± 24 days). The ejection fraction (EF) and the telediastolic (TDV) and telesystolic (TSV) volumes of the left ventricle were determined by radiological ventriculography, before the CTA and at ≥ 4 months later (the method of areas and lengths, OAD 30o). Thirty eight patients had not restenosis (GI) and 26 had one (GII). The evolution of TDV was equivalent in GI and GII (ΔTDV (ml): +1 ± 18 vs + 10 ± 30, NS), while the evolution of TSV and EF were better in GI than in GII (ΔTSV (ml): -6 ± 19 vs + 8 ± 28, p < 0.01; ΔEF (%): +5 ± 9 vs - 13 ± 10, p < 0.02). The predictive parameters independent, of the evolution of EF, were: [1] - the extension of the reversible lacuna in MTS (p < 0.002) and [2] - the absence of restenosis (p < 0.002). The only predictive parameter of the evolution of TDV was the extension of the reversible lacuna in MTS (p < 0.02). After coronary angioplasty in the territory of a recent infarction and the evolution of EF as well as that of TDV (remodeling) depends on the residual myocardial viability