Assessing myocardial viability: Correlation of myocardial wall motion abnormalities and pathologic Q waves with technetium 99m sestamibi single photon emission computed tomography

The clinical benefit of coronary revascularization depends largely on the viability of the myocardium that is perfused. To determine if the combination of electrocardiogram and left ventriculography findings could be used to predict viability, the presence of pathologic Q waves and wall motion abnormalities on contrast left ventriculography were correlated with findings on stress sestamibi scanning in 201 patients. Wall motion was abnormal in 51.5% of 103 Q regions; 30 (56.6%) of these had fixed sestamibi defects, and 22.6% had fully or partially reversible sestamibi defects. Q waves were associated with 43.4% of 122 regions with wall motion abnormality; 67.9% of these areas had fixed or partially fixed sestamibi defects. Wall motion abnormalities were present in 46.1% of 104 areas with fixed sestamibi defects. Although there was a statistically significant correlation among Q waves, left ventricular wall motion abnormalities, and stress sestamibi uptake (and various combinations of these data), the relatively large number (53.8%) of discordant findings (e.g., normal ventricular wall motion in the presence of fixed sestamibi defects) suggests that nonviability cannot be assumed without at least assessing both contractile left ventricular motion and metabolic (e.g., sestimibi scanning) function.