Imaging Would coronary collaterals to the infarct-related artery serve as a marker of viability in patients with prior myocardial infarction? A study with trimetazidine- 99m Tc-sestamibi imaging ☆ Amr Adel, Abdel-Hamid Mohamed, Wail Nammas ⁎ Faculty of Medicine, Cardiology Department, Ain Shams University, Cairo, Egypt Received 4 September 2009; received in revised form 9 November 2009; accepted 13 November 2009 Abstract Background: Visualization of collateral circulation to the infarct-related artery on coronary angiography was suggested to predict viability in the infarct zone as demonstrated by dobutamine stress echocardiography. Methods and materials: We enrolled 30 consecutive patients referred from our catheterization labs with prior Q-wave myocardial infarction at least 6 months before study enrollment. Patients were classified according to the presence of collaterals to the infarct-related artery into two groups: collateral group with Rentrop Grade 1–3 collaterals, and noncollateral group with Rentrop Grade 0 collaterals. Patients underwent resting 99m Tc-sestamibi imaging study with the administration of trimetazidine, using the standard technique, within 4 days of coronary angiography. Viability in a specific territory was defined when at least 50% of its individual segments were classified as viable. Results: The visualization of collaterals by coronary angiography was able to predict viability in the territory supplied by the infarct-related artery with a sensitivity of 88.2%; specificity of 53.8%; positive and negative predictive values of 71.4% and 77.8%, respectively; and a diagnostic accuracy of 73.3%. The presence of viability increased progressively, in a statistically significant manner, from Rentrop Grade 0 to Grade 1 and Grade 2 [2 (22.2%), 5 (50%), 10 (91%), respectively, P=.04]. Conclusions: Visualization of coronary collaterals to the infarct-related artery by coronary angiography may predict with a high sensitivity but a low specificity the presence of viability in the territory supplied by that artery. © 2011 Elsevier Inc. All rights reserved. Keywords: Nuclear cardiology; Coronary collaterals; Myocardial viability 1. Introduction With the vast progress in the field of coronary revascularization over the past two decades, predicting the presence of viable myocardium has acquired great clinical importance, especially in patients assigned for interventional treatment [1]. Myocardial viability represents impairment in contractility that is potentially reversible if blood supply is adequately restored [2]. Assumingly, improving blood flow to viable dysfunctional zones results in subsequent improve- ment of regional and global left ventricular function, heart failure symptoms, functional capacity, and long-term survival [3]. This paradigm was supported by the results of several studies where only patients with severe left ventricular dysfunction who had viable myocardium im- proved after revascularization [4]. Cardiovascular Revascularization Medicine 12 (2011) 41 – 46 ☆ Financial disclosure: No author has a conflict of interest to declare. ⁎ Corresponding author. Faculty of Medicine, Cardiology Department, Ain Shams University Hospitals, Ain Shams University, Abbassia, Cairo P.O. 11381, Egypt. Tel.: +20 12 4063718; fax: +20 2 24820416. E-mail address: wnammas@hotmail.com (W. Nammas). 1553-8389/09/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.carrev.2009.11.004