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7.3 Comparison of hospital pre-discharge sub-maximal Thallium scintigraphy and 3 weeks maximal Thallium scintigraphy in evaluation of patients with uncomplicated acute myocardial infarction
Poster Display III F r i d a y , M a y 4, 2 0 0 1 10:00 - 12:00
7.1
7.3
Prevalence of myocardial viability assessed by single-photon emission computed tomography in patients with chronic ischemic left veutrienlar dysfunction.
Comparison of hospital pre-discharge sub-maximal Thallium seintigraphy and 3 weeks maximal Thallium scintigraphy in evaluation of patients with uncomplicated acute myocardial infarction. A Allam, M Abd-Alwahab, I Kholefy, I Shawky, M Mansoar, H EIGindy, A Sharef, S Elhawary, M Matawaa, A Mostafa, L Ezat, K Elshantaly. Cairo, Egypt.
A.F.L. Schinkel 1, J.J. Bax 2, F.B. Sozzi 1, E. Boersma 1, R. Valkema I, A. Elhendy 1, J.R.T.C. Roelandt I, D. Poldermansk Erasmus University Medical Center Rotterdam and Leiden University Medical Center, The Netherlands
Background: The prevalence of myocardial viability assessed by technetium99m (Tc-99m)-tetrofosmin/fluorine-18-fluorodeoxyglucose (FDG) singlephoton emission computed tomography (SPECT) is important to identify how many patients with ischemic cardiomyopathy can potentially benefit from revascularization. Methods: A total of 104 patients with chronic coronary artery disease and severely depressed left ventricular (LV) function presenting with heart failure symptoms tmderwent Tc-99m-tetrofosmin/FDG SPECT imaging to assess myocardial perfusion and metabolism. Two strategies for assessing viability in dysfunctional myocardium were used: perfusion imaging alone or the combination of perfusion and metabolic imaging. ResuRs: According to perfusion imaging alone, 56 (54%) patients were classified viable, whereas 48 (46%) patients were classified nonviable. Application of perfusion imaging in combination with metabolic imaging identified 7 (7%) additional patients with significant viability, thus classifying 63 (61%) patients as viable and 41 (39%) as nonviable. Conclusion: Based on the presence of viable myocardium, 61% of patients with chronic coronary artery disease and depressed LVEF presenting with heart failure symptoms may be considered for coronary revascularization. The combination of perfusinn and metabolic imaging identified more patients with significant viability than myocardial perfusion imaging alone.
Thirty-two patients (pts) with their first acute uncomplicated MI (U-MI) underwent both pre-hospital discharge (PHD) submaximal (Smax) stress re-injection thallium scintigraphy (S-R TI) and 3 weeks (3w) maximal (max) S-RTI. Mean age 41 + 8yrs, 30/32 were males, risk factors 2.4 +- .91. Twentyfour had anterior MI, 7 had inferior and 1 lateral MI. 14/32 pts (43%) received thrombolytic therapy. Chest pain occurred in 10/32 pts during Smax S-RTI versus (Vs) 16/32 pts during max S-RTI P<0.03. ST depression occurred in 5/32 during Smax S-RTI Vs 8/32 during max S-RTI P=NS. Peak (P) heart rate with Smax S-RTI 132+9 Vs 159+-18 with max S-RTI P<0.0001, P systolic blood pressure 141 _+18 Vs 155 t 20 P<0.0001. Total number of perfusion defects (DF) 11 +- 2 with Smax S-RTI Vs 11.3-+ 2.2 with max S-RTI P-NS. Reversible DF 8.1 -+2.1 Vs 8.4-+2.7 P-NS, Fixed DF 2.9+- 2.4 Vs 2.8 -+ 2.7 P=NS, Sum Stress Score 21.5 +- 7.8 Vs 22.1 +- 7.4 P-NS. Thus, Smax S-RT1 performed PHD after U-MI helps early evaluation and has the same diagnostic power for identification of residual myocardial ischaemia equivalent to max S-RTI performed at 3W following hospital discharge.
F R I D A Y
7.2 Myocardial perfnsion (spect tc99m sestamibi) in sistemyc generalized lupus (leg). Angyograpghic correlation. Orea-T A, S~nchez-G J,, Rebollar-G V . P6rez-A JC Dnrantes-G J, Narvaez-D R; Asensio-L E, Oseguera-M J, Navarrete-G R, Ochoa V, A Rangel; Sepfilveda J, Gonzalez T O. Instituto Nacional de Ciencias M6dicas y Nutrici6n "S Z". Mexico City, Mexico The coronary artery disease is a frequent cause of morbi-mortality in patients with SLE. The incidence of this condition is nine fold than patients without SLE. Wherever the myocardial perfusion abnormalities screened whit SPECT/Tc99 sestamibi may be identified in more patients with microvascular alterations without epicardial coronary abnormalities. With the propose to know this relation, we designed prospectively this study. Material and Method: Two hundred thirty-seven consecutive patients with LEG according ACR were selected from Lupus Clinic. A standardized questionnaire about chest pain (presence, type, duration) and direct interview y those of them that answered to have suggesting ischemic (Group A = GA), atypical (Group B =GB), and non ischemic chest pain (Group C = GC). Physical exam, resting electrocardiogram and SPECT were done in GA, GB, and an random saple of GC. Other risk factors as systemic hypertension, smoking, dyslipidemia, use and length of prednisone (Pd)and demographic characteristic were analyzed. Results: A significant difference were found in Pd dose (mg/day) in GA (34± 14.9) Vs (16.42± 13.64), P 0.01; G A v s GC (10± 4.47), P 0.0004.SPECT was abnormal in all patients of GA and 21 in GB and normal in all patients in GC. The mean involved territories/patients damage was 8.3 + 2.2 without statically significant difference between the groups, The angiopraphic study shown a coronary obstructive lesions in 4/5 patients in GA vs 3/16 in GB without significant differences in the principal involved coronary vessels. Non other significant differences were found between the groups. Conclusion: The ischemic heart disease in lupic patients evaluated by SPECT in a save and sensible procedure to detect microvascular damage, (included pediatric population in other experiences) and prematury way to detect epieardial coronary obstructive lesions in asyntomatic and /or atipycal chest pain in patients using more than 10 mg/day of prednisone.
Journal of Nuclear Cardiology January/February 2001
7.4
M A Y
Patient tolerance of two vasodilator stress protocols for myocardial perfusion scintigraphy: dipyridamole vs adenosine. LEJ Thomson*, MT Lincoln, B Coutinho, V Bush, KC Allman. Nuclear Cardiology, Department of Nuclear Medicine, Concord Hospital, Concord NSW. Aim: To compare patient perception of general side-effects associated with two forms of phannacologic stress testing approved for myocardial perfusion imaging. Methods: A questionnaire was administered to 200 consecutive consenting patients after receiving either a standard 10 minute 0.56mg/kg dipyridamole stress test including aminophylline reversal vs a 4 minute adenosine infusion at 140mcgs/kg/min. Questions related to the constitutional side-effects of vasodilator stress with responses scored on a 5 point severity scale from 0=nil to 4-~macceptable. The two groups were compared using Mann-Whitney U test. Data shown are means 4- standard error: adenosine dipyridamole p Headache Face Flushing Nausea Chest pain Abdo. Pain Leg Pain Dyspnoea Overall
0.67 ± 0.86 ± 0.20 • 0.50 ± 0.70 ± 0.12 ± 0.70 ± 0.81 ±
.079 .078 .049 .076 .026 .038 .087 .076
0.86 ± .078 0.60 ± .070 0.33 ± .065 0.53 ± .076 0.19 a_ .056 0.24 ± .059 0.62 ± .071 0.88 ± .079
0.06 0.02* 0.30 0.75 0.37 0.29 0.85 0.60
Conclusion: Both forms of vasodilator testing yielded low and similar tolerance scores. This indicates good patient acceptance for both agents in the patients tested with no significant differences detected. In view of this equivalence the shorter adenosine protocol appears to be the vasodilator stress of choice for myocardial perfusion imaging.
$41
7.1
7.3
Prevalence of myocardial viability assessed by single-photon emission computed tomography in patients with chronic ischemic left veutrienlar dysfunction.
Comparison of hospital pre-discharge sub-maximal Thallium seintigraphy and 3 weeks maximal Thallium scintigraphy in evaluation of patients with uncomplicated acute myocardial infarction. A Allam, M Abd-Alwahab, I Kholefy, I Shawky, M Mansoar, H EIGindy, A Sharef, S Elhawary, M Matawaa, A Mostafa, L Ezat, K Elshantaly. Cairo, Egypt.
A.F.L. Schinkel 1, J.J. Bax 2, F.B. Sozzi 1, E. Boersma 1, R. Valkema I, A. Elhendy 1, J.R.T.C. Roelandt I, D. Poldermansk Erasmus University Medical Center Rotterdam and Leiden University Medical Center, The Netherlands
Background: The prevalence of myocardial viability assessed by technetium99m (Tc-99m)-tetrofosmin/fluorine-18-fluorodeoxyglucose (FDG) singlephoton emission computed tomography (SPECT) is important to identify how many patients with ischemic cardiomyopathy can potentially benefit from revascularization. Methods: A total of 104 patients with chronic coronary artery disease and severely depressed left ventricular (LV) function presenting with heart failure symptoms tmderwent Tc-99m-tetrofosmin/FDG SPECT imaging to assess myocardial perfusion and metabolism. Two strategies for assessing viability in dysfunctional myocardium were used: perfusion imaging alone or the combination of perfusion and metabolic imaging. ResuRs: According to perfusion imaging alone, 56 (54%) patients were classified viable, whereas 48 (46%) patients were classified nonviable. Application of perfusion imaging in combination with metabolic imaging identified 7 (7%) additional patients with significant viability, thus classifying 63 (61%) patients as viable and 41 (39%) as nonviable. Conclusion: Based on the presence of viable myocardium, 61% of patients with chronic coronary artery disease and depressed LVEF presenting with heart failure symptoms may be considered for coronary revascularization. The combination of perfusinn and metabolic imaging identified more patients with significant viability than myocardial perfusion imaging alone.
Thirty-two patients (pts) with their first acute uncomplicated MI (U-MI) underwent both pre-hospital discharge (PHD) submaximal (Smax) stress re-injection thallium scintigraphy (S-R TI) and 3 weeks (3w) maximal (max) S-RTI. Mean age 41 + 8yrs, 30/32 were males, risk factors 2.4 +- .91. Twentyfour had anterior MI, 7 had inferior and 1 lateral MI. 14/32 pts (43%) received thrombolytic therapy. Chest pain occurred in 10/32 pts during Smax S-RTI versus (Vs) 16/32 pts during max S-RTI P<0.03. ST depression occurred in 5/32 during Smax S-RTI Vs 8/32 during max S-RTI P=NS. Peak (P) heart rate with Smax S-RTI 132+9 Vs 159+-18 with max S-RTI P<0.0001, P systolic blood pressure 141 _+18 Vs 155 t 20 P<0.0001. Total number of perfusion defects (DF) 11 +- 2 with Smax S-RTI Vs 11.3-+ 2.2 with max S-RTI P-NS. Reversible DF 8.1 -+2.1 Vs 8.4-+2.7 P-NS, Fixed DF 2.9+- 2.4 Vs 2.8 -+ 2.7 P=NS, Sum Stress Score 21.5 +- 7.8 Vs 22.1 +- 7.4 P-NS. Thus, Smax S-RT1 performed PHD after U-MI helps early evaluation and has the same diagnostic power for identification of residual myocardial ischaemia equivalent to max S-RTI performed at 3W following hospital discharge.
F R I D A Y
7.2 Myocardial perfnsion (spect tc99m sestamibi) in sistemyc generalized lupus (leg). Angyograpghic correlation. Orea-T A, S~nchez-G J,, Rebollar-G V . P6rez-A JC Dnrantes-G J, Narvaez-D R; Asensio-L E, Oseguera-M J, Navarrete-G R, Ochoa V, A Rangel; Sepfilveda J, Gonzalez T O. Instituto Nacional de Ciencias M6dicas y Nutrici6n "S Z". Mexico City, Mexico The coronary artery disease is a frequent cause of morbi-mortality in patients with SLE. The incidence of this condition is nine fold than patients without SLE. Wherever the myocardial perfusion abnormalities screened whit SPECT/Tc99 sestamibi may be identified in more patients with microvascular alterations without epicardial coronary abnormalities. With the propose to know this relation, we designed prospectively this study. Material and Method: Two hundred thirty-seven consecutive patients with LEG according ACR were selected from Lupus Clinic. A standardized questionnaire about chest pain (presence, type, duration) and direct interview y those of them that answered to have suggesting ischemic (Group A = GA), atypical (Group B =GB), and non ischemic chest pain (Group C = GC). Physical exam, resting electrocardiogram and SPECT were done in GA, GB, and an random saple of GC. Other risk factors as systemic hypertension, smoking, dyslipidemia, use and length of prednisone (Pd)and demographic characteristic were analyzed. Results: A significant difference were found in Pd dose (mg/day) in GA (34± 14.9) Vs (16.42± 13.64), P 0.01; G A v s GC (10± 4.47), P 0.0004.SPECT was abnormal in all patients of GA and 21 in GB and normal in all patients in GC. The mean involved territories/patients damage was 8.3 + 2.2 without statically significant difference between the groups, The angiopraphic study shown a coronary obstructive lesions in 4/5 patients in GA vs 3/16 in GB without significant differences in the principal involved coronary vessels. Non other significant differences were found between the groups. Conclusion: The ischemic heart disease in lupic patients evaluated by SPECT in a save and sensible procedure to detect microvascular damage, (included pediatric population in other experiences) and prematury way to detect epieardial coronary obstructive lesions in asyntomatic and /or atipycal chest pain in patients using more than 10 mg/day of prednisone.
Journal of Nuclear Cardiology January/February 2001
7.4
M A Y
Patient tolerance of two vasodilator stress protocols for myocardial perfusion scintigraphy: dipyridamole vs adenosine. LEJ Thomson*, MT Lincoln, B Coutinho, V Bush, KC Allman. Nuclear Cardiology, Department of Nuclear Medicine, Concord Hospital, Concord NSW. Aim: To compare patient perception of general side-effects associated with two forms of phannacologic stress testing approved for myocardial perfusion imaging. Methods: A questionnaire was administered to 200 consecutive consenting patients after receiving either a standard 10 minute 0.56mg/kg dipyridamole stress test including aminophylline reversal vs a 4 minute adenosine infusion at 140mcgs/kg/min. Questions related to the constitutional side-effects of vasodilator stress with responses scored on a 5 point severity scale from 0=nil to 4-~macceptable. The two groups were compared using Mann-Whitney U test. Data shown are means 4- standard error: adenosine dipyridamole p Headache Face Flushing Nausea Chest pain Abdo. Pain Leg Pain Dyspnoea Overall
0.67 ± 0.86 ± 0.20 • 0.50 ± 0.70 ± 0.12 ± 0.70 ± 0.81 ±
.079 .078 .049 .076 .026 .038 .087 .076
0.86 ± .078 0.60 ± .070 0.33 ± .065 0.53 ± .076 0.19 a_ .056 0.24 ± .059 0.62 ± .071 0.88 ± .079
0.06 0.02* 0.30 0.75 0.37 0.29 0.85 0.60
Conclusion: Both forms of vasodilator testing yielded low and similar tolerance scores. This indicates good patient acceptance for both agents in the patients tested with no significant differences detected. In view of this equivalence the shorter adenosine protocol appears to be the vasodilator stress of choice for myocardial perfusion imaging.
$41