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Adenosine stress test and 99m-Tc-tetrofosmin SPECT imaging for the diagnosis of C.A.D.
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
Abstracts Monday morning, April 7, 1997
8.10 IS 99M-TC-TETRAFOSMIN SPECT USEFULL CORONARY ANGIOGRAPHY IN CASI~ OF A NON-DIAGNOSTIC STRESS EKG?
8.12 BEFORE
F.A.van der Weel, M.J.Nooitgedacht-de Haas, W. Kolsters, M.LM. Cramer, Ziekenhuis Eemland Amersfoort, the Netherlands. Myocardial spect (MYSPECT) was performed in 390 patients suffering from chest pains. Cardiac stress was created by symptom-limited bicycle ergometry or intravenous dipyridamole infusion (0,56 mg/kg in 4 minutes). A two day protocol with 750 MBq 99mTcTetrafosmin for the stress and rest studies was used. A subgroup of 153 patients,102 man, (age 44-69) and 51 women, (age 46-75) who underwent Coronary Angiography because of a positive Myspect result was studied. The stress EKG was non diagnostic in 67% of these 153 cases and for this reason alone they would not be candidates for a coronary angiography. Followup data from this group showed that 20% underwent bypass surgery and another 20% underwent a PTCA. Without the Myspect data a considerable delay in treatment was the least to be expected. We conclude that early Myspect with 99mTc Tetrafosmin is usefull in the workup of patients with a non diagnostic stress EKG and chest pain. This study shows that a considerable number of patients would otherwise be treated in a suboptimal way.
Tc-99m SESTA-MIBI SPECT IMAGING IN ANGINA PATIENTS WITH ECHOCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY (LVH) S C Chae, H S Park, Y K Cho, J Lee, J E Jun, W H Park, Kyungpook National University, Taegu, Korea Tc-99m sesta-MIBI myocardial scan was performed with either exercise (n= 42) or adenosine (n= 41) stress in 83 anginal patients with normal ECG. Fifty four patients had significant coronary artery disease ( > 50%) in coronary angiogram. Overall sensitivity and specificity of the SPECT imaging were 87%, 76%, respectively. The patients were divided into 2 groups by the absence (group 1, n= 51) or presence (group 2, n= 32) of echocardiographic LVH; LVH was diagnosed if left ventricular mass in M-mode echocardiogram exceeds 131 g/m 2 in men, 100 g/m 2 in women. Sensitivity of the SPECT imaging w a s 86 % in group 1 and 88 % in group 2 (p= NS), respectively. Specificity of the SPECT imaging w a s 86 % in group 1 and 67 % in group 2 (p= NS), respectively. Echocardiographic LVH does not appear to affect the diagnostic accuracy of sestaMIBI myocardial SPECT imaging in the anginal patients without evidence of ECG LVH.
8.11
8.13
AdenosineScintigraphyin PatientswithChronicObstructive PulmonaryDisease:RoutinePretreatmentwitha Bronehodilator DonaldL. Johnston,DavidO. Hedge, RobertB. Glynn, Raymond J. Gibbons. Mayo Clinic, Rochester,MN, USA
ADENOSINE STRESS TEST AND 99'~-Te-TETROFOSMIN SPECT IMAGING FOR THE DIAGNOSIS OF C.A.D. L Lumbreras, D Becetwa, R Nieto, B Fem6ndez, .4 Nevado, 0 Padilla andJJM Sampere. Hospital Clinico Universitario. Granada (SPAL\:).
To determineif pretreatmentwithan inhaledbronchodilator(BD) wouldallowadenosineto be usedsafelyin pts withCOPD during peffusionscintigraphy,94 pts were studiedwithpulmonaryfunction testingbefore,duringand 15 rainafter infusionof a graduateddose of adenosineto a maximumdoseof 140 ug/kg/min(monitoredpts). Pts witha forcedexpiratoryvolumein 1 sec (FEV1) of <30% (predictedfor age), FEV1 30-40°/° + BD response>15% or FEV1 >40% + BD response>30% receiveddobutamine.MildCOPD was presentin 39 pts (FEV1- 2.10+0.63 Umin); moderate-severe COPD was presentin 55 (FEVl- 1~9+0.38 L/rnin).Upon completionof thisportionof the study_ptswithsuspectedor knownCOPD receivednebulizedAlbuterol(2.5 rag)followedby adenosinewithoutsimultaneousPFT (n=80 - unmonitoredpt). The changesin FEV1 withadenosinewere not differentfor mildvs severeCOPD. One monitoredpt had adenosinedecreaseddue to a decreasein FEV1 >20% butwas asymptomatic.No unmonitoredpt had adenosinedecreaseddueto dyspnea. FEVl (mean - L/rain) Monitored rest p-BD 140 ug/kg/min 15 min post pts (n=94) 1.69 1.83 1.78 1.78 p<0.001 In summary,adenosineis now routinelygivento selectedpts with moderateand severeCOPD usinga nebulizedBD pretreatment withoutthe needfor simultaneouspulmonaryfunctionmonitoring.
OBJECTIVEs: The purpose was to evaluate (1) the usefiflness of adenosine infusion coupled with 9~"Tc-tetrofosminscintigrap~' in the assessment of CAD and (2) compare ~ o protocols of s~ess with adenosine (infusion alone vs combining with exercise) to determine the presence of side effects and inaaging euali~', METHODS: n= 112 consecutivepatients were randomized to two study groups: (A) 6 rain of adenosine infusion alo-ae (140 ;.~gr/kg/minx6 man) and tl~) 6 nfin of combined exercise with adenosin, Protocol stress/rest. RESULTS: DA n=30
Sensib. Espec. VPP VPN E.D
[
CX Gr-A
I Gr-B
CD
Gr-A
Gr-B
Gr-A
0.88
1.00
0.75
0.83
1.00
Gr-B 0.75
0.86 0.88
0.80 0.91
1.00 1.00
1.00 1.00
1.00 1.00
1.00 1.00
0.86
1.00
0.92
0.90
1.00
0.78
O87
093
0 93
0.93
l ,I)O
('1.87
Additional exercise caused signilieantly increases in heart rate (16,78 vs 0.5; p<0.0001). Systolic and diastolic BP also increased compared with the decrease in BPa seen with adenosine alone (BPs:9. lmmlIg; BPd:5.95). We report a reducing in noncardiac side effects combining exercise with adenosine infusion.
$7
Abstracts Monday morning, April 7, 1997
8.10 IS 99M-TC-TETRAFOSMIN SPECT USEFULL CORONARY ANGIOGRAPHY IN CASI~ OF A NON-DIAGNOSTIC STRESS EKG?
8.12 BEFORE
F.A.van der Weel, M.J.Nooitgedacht-de Haas, W. Kolsters, M.LM. Cramer, Ziekenhuis Eemland Amersfoort, the Netherlands. Myocardial spect (MYSPECT) was performed in 390 patients suffering from chest pains. Cardiac stress was created by symptom-limited bicycle ergometry or intravenous dipyridamole infusion (0,56 mg/kg in 4 minutes). A two day protocol with 750 MBq 99mTcTetrafosmin for the stress and rest studies was used. A subgroup of 153 patients,102 man, (age 44-69) and 51 women, (age 46-75) who underwent Coronary Angiography because of a positive Myspect result was studied. The stress EKG was non diagnostic in 67% of these 153 cases and for this reason alone they would not be candidates for a coronary angiography. Followup data from this group showed that 20% underwent bypass surgery and another 20% underwent a PTCA. Without the Myspect data a considerable delay in treatment was the least to be expected. We conclude that early Myspect with 99mTc Tetrafosmin is usefull in the workup of patients with a non diagnostic stress EKG and chest pain. This study shows that a considerable number of patients would otherwise be treated in a suboptimal way.
Tc-99m SESTA-MIBI SPECT IMAGING IN ANGINA PATIENTS WITH ECHOCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY (LVH) S C Chae, H S Park, Y K Cho, J Lee, J E Jun, W H Park, Kyungpook National University, Taegu, Korea Tc-99m sesta-MIBI myocardial scan was performed with either exercise (n= 42) or adenosine (n= 41) stress in 83 anginal patients with normal ECG. Fifty four patients had significant coronary artery disease ( > 50%) in coronary angiogram. Overall sensitivity and specificity of the SPECT imaging were 87%, 76%, respectively. The patients were divided into 2 groups by the absence (group 1, n= 51) or presence (group 2, n= 32) of echocardiographic LVH; LVH was diagnosed if left ventricular mass in M-mode echocardiogram exceeds 131 g/m 2 in men, 100 g/m 2 in women. Sensitivity of the SPECT imaging w a s 86 % in group 1 and 88 % in group 2 (p= NS), respectively. Specificity of the SPECT imaging w a s 86 % in group 1 and 67 % in group 2 (p= NS), respectively. Echocardiographic LVH does not appear to affect the diagnostic accuracy of sestaMIBI myocardial SPECT imaging in the anginal patients without evidence of ECG LVH.
8.11
8.13
AdenosineScintigraphyin PatientswithChronicObstructive PulmonaryDisease:RoutinePretreatmentwitha Bronehodilator DonaldL. Johnston,DavidO. Hedge, RobertB. Glynn, Raymond J. Gibbons. Mayo Clinic, Rochester,MN, USA
ADENOSINE STRESS TEST AND 99'~-Te-TETROFOSMIN SPECT IMAGING FOR THE DIAGNOSIS OF C.A.D. L Lumbreras, D Becetwa, R Nieto, B Fem6ndez, .4 Nevado, 0 Padilla andJJM Sampere. Hospital Clinico Universitario. Granada (SPAL\:).
To determineif pretreatmentwithan inhaledbronchodilator(BD) wouldallowadenosineto be usedsafelyin pts withCOPD during peffusionscintigraphy,94 pts were studiedwithpulmonaryfunction testingbefore,duringand 15 rainafter infusionof a graduateddose of adenosineto a maximumdoseof 140 ug/kg/min(monitoredpts). Pts witha forcedexpiratoryvolumein 1 sec (FEV1) of <30% (predictedfor age), FEV1 30-40°/° + BD response>15% or FEV1 >40% + BD response>30% receiveddobutamine.MildCOPD was presentin 39 pts (FEV1- 2.10+0.63 Umin); moderate-severe COPD was presentin 55 (FEVl- 1~9+0.38 L/rnin).Upon completionof thisportionof the study_ptswithsuspectedor knownCOPD receivednebulizedAlbuterol(2.5 rag)followedby adenosinewithoutsimultaneousPFT (n=80 - unmonitoredpt). The changesin FEV1 withadenosinewere not differentfor mildvs severeCOPD. One monitoredpt had adenosinedecreaseddue to a decreasein FEV1 >20% butwas asymptomatic.No unmonitoredpt had adenosinedecreaseddueto dyspnea. FEVl (mean - L/rain) Monitored rest p-BD 140 ug/kg/min 15 min post pts (n=94) 1.69 1.83 1.78 1.78 p<0.001 In summary,adenosineis now routinelygivento selectedpts with moderateand severeCOPD usinga nebulizedBD pretreatment withoutthe needfor simultaneouspulmonaryfunctionmonitoring.
OBJECTIVEs: The purpose was to evaluate (1) the usefiflness of adenosine infusion coupled with 9~"Tc-tetrofosminscintigrap~' in the assessment of CAD and (2) compare ~ o protocols of s~ess with adenosine (infusion alone vs combining with exercise) to determine the presence of side effects and inaaging euali~', METHODS: n= 112 consecutivepatients were randomized to two study groups: (A) 6 rain of adenosine infusion alo-ae (140 ;.~gr/kg/minx6 man) and tl~) 6 nfin of combined exercise with adenosin, Protocol stress/rest. RESULTS: DA n=30
Sensib. Espec. VPP VPN E.D
[
CX Gr-A
I Gr-B
CD
Gr-A
Gr-B
Gr-A
0.88
1.00
0.75
0.83
1.00
Gr-B 0.75
0.86 0.88
0.80 0.91
1.00 1.00
1.00 1.00
1.00 1.00
1.00 1.00
0.86
1.00
0.92
0.90
1.00
0.78
O87
093
0 93
0.93
l ,I)O
('1.87
Additional exercise caused signilieantly increases in heart rate (16,78 vs 0.5; p<0.0001). Systolic and diastolic BP also increased compared with the decrease in BPa seen with adenosine alone (BPs:9. lmmlIg; BPd:5.95). We report a reducing in noncardiac side effects combining exercise with adenosine infusion.
$7