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Comparison of Sestamibi and TL-201 for CAD diagnosis in clinical routine: Is there really a gain?
Journal of Nuclear Cardiology Volume 6, N u m b e r 1, Part 2
35.38 COMPARISON OF SESTAMIBI AND TL-201 FOR CAD DIAGNOSIS IN CLINICALROUTINE: IS THEREREALLYA GAIN.'?
V.Carnovale, S.Sestini, R.Sciagr&, A.Ferraro, L.Poggesi, G.F.Gensini. Nuclear Medicine, University of Florence; Florence, Italy. Prospective studies in the same patients have shown that Sestamibi and TI-201 achieve similar accuracy for CAD diagnosis. Because of pre- and/or post-referral biases, it is difficult to verify which results are obtained in clinical routine. To this aim, we compared patients referred by the same cardiologists, submitted to SPECT with similar modalities, evaluated by the same observer with unchanging criteria, and all studied thereafter with coronary angiography. The single difference between the two groups was in the tracer: TI-201 during year 1995 and Sestamibi during 1996. Data were available for 119 patients (56 TI-201, 63 Sestamibi). For the diagnosis of CAD, TI-201 showed 91% sensitivity, 33% specificity and 82% accuracy. The related values using Sestamibi were 86%, 85% (p < 0.05) and 85%, respectively. Involvement of multiple vessels was correctly detected by TI201 in 57% of patients with multi-vessel CAD and by Sestamibi in 66%. For the identification of the affected vessels, the results of TI-201 were sensitivity 56%, specificity 84% and accuracy 64%, and those of Sestamibi 61%, 89% and 73%, respectively. These data confirm the results of previous comparative studies and indicate that Sestamibi is slightly superior to TI-201 in current clinical routine.
Abstracts Tuesday afternoon, April 20, 1999
$71
35.40
99mTc-Sestamibi SPECT: Combination of pharmacologic and exercise stress is superior to pharmacologic stress S.Gr6ber, H.Vogt, G.Graf, P.Heidenreich. Klinik fiJr Nuklearmedizin, Zentralklinikum Augsburg, Germany The results of pharmacologic stress with 0.56 m 9 dipyridamoleper kg body-weight were compared with a combined dipyridamole & exercise stress protocol. In 200 pts unable to exercise adequately myocardial scintigraphy was done with a three-headed Picker camera equipped with fan - beam collimators. The acquired data were processed by applying the so called simultaneous transmission and emission protocol (STEP). Results: pharm, stress comb. stress
LAD sens. spec. 73% 65% 90% 81%
RCX sens. spec. 79% 75% 85% 83%
RCA sens. spec. 69% 86% 92% 86%
Conclusion: In p.ts who are unable to exercise adequately a combination of pharmacologic and exercise stress is superior to pharmacologic stress in determination of extent and severity of coronary artery disease. The combined stress protocol is as safe and inexpensive as the pure dipyridamole stress protocol.
T U E S D A Y P M
35.39
35.41
H Y P E R T E N S I V E BLOOD P R E S S U R E R E S P O N S E TO EXERCISE AND ISCHEMIC ST-T SEGMENT CHANGES: CORRELATION WITH MYOCARDIAL PERFUSION SCINTIGRAPHY S.Kirac,F.J.Th. Wackers.Yale University. New Haven, CT
QUALITY OF LIFE 7 YEARS AFTER EXERCISE THALLIUM SPECT J.Milavetz, T.Miller, D.Hodge, R.Gibbons. Mayo Clinic, Rochester, Minnesota, USA.
The mechanism and significance of ischemic-appearing (false-positive) electrocardiographic ST-T segment changes to exercise are unclear. We hypothesized that in selected patients (pts) this may be due to nontransmural ischemia caused by hypertensive blood pressure (BP) response, not detectable by exercise myocardial perfusion imaging (MPI). We evaluated the association between hypertensive BP response to exercise (systolic BP >_180 and diastolic BP >_ 95 mmHg) and ischemic ST-T segment changes in 217 pts with normal exercise MPI. 128 pts (61%) had ischemic ST-T segment changes on the exercise ECG; 89 pts (39%) had normal exercise ECG. 130 pts (60%) had hypertensive BP response, 87 pts (40%) had normal BP response to exercise. There were no significant differences between the two groups for age,sex, risk factors for coronary artery disease and hemodynamic parameters on exercise. Patients with ischemie ST-T segment changes did not have a significantly greater prevalence of hypertensive BP response compared to pts with normal ST-T segment during exercise (62% vs 57%). This was also true when multiple other cut-off levels for hypertensive BP response were analyzed. Conclusion: In patients with normal exercise MPI, ischemic-appearing ST-T segment changes are not significantly associated with hypertensive BP response. Thus, ischemic ECG changes can not be explained by demand-nontransmural ischemia undetected by myocardial perfusion images.
Exercise T 1-SPECT has been shown to predict survival and cardiac events, but whether it can predict quality of life (QOL) is unknown. 2,253 patients (59+10 years, 1,264 male; 989 female) who had undergone an exercise T1-SPECT 7.3_+0.9 years earlier ranked their perceived general health (PGH) among 5 levels ("excellent" to "poor") and ranked their perceived cardiac abilities (PCA) among 4 levels ("can do anything" to "have trouble doing almost anything"). A summed reversibility score (SRS) was assigned for abnormal scans to determine ischemia extent and severity. Patients with normal (n=1,244) and abnormal (n=l,009) scans did not differ with respect to PGH (p=0.342), but did significantly differ with respect to PCA (p<0.001). Of 622 pts reporting excellent PCA, 403 (65%) had normal scans. SRS was not associated with PGH (p=0.63) but was associated with PCA (p<0.001). In conclusion, T 1-SPECT appears to predict PCA but not PGH during long-term follow up.
A P R I L 20
35.38 COMPARISON OF SESTAMIBI AND TL-201 FOR CAD DIAGNOSIS IN CLINICALROUTINE: IS THEREREALLYA GAIN.'?
V.Carnovale, S.Sestini, R.Sciagr&, A.Ferraro, L.Poggesi, G.F.Gensini. Nuclear Medicine, University of Florence; Florence, Italy. Prospective studies in the same patients have shown that Sestamibi and TI-201 achieve similar accuracy for CAD diagnosis. Because of pre- and/or post-referral biases, it is difficult to verify which results are obtained in clinical routine. To this aim, we compared patients referred by the same cardiologists, submitted to SPECT with similar modalities, evaluated by the same observer with unchanging criteria, and all studied thereafter with coronary angiography. The single difference between the two groups was in the tracer: TI-201 during year 1995 and Sestamibi during 1996. Data were available for 119 patients (56 TI-201, 63 Sestamibi). For the diagnosis of CAD, TI-201 showed 91% sensitivity, 33% specificity and 82% accuracy. The related values using Sestamibi were 86%, 85% (p < 0.05) and 85%, respectively. Involvement of multiple vessels was correctly detected by TI201 in 57% of patients with multi-vessel CAD and by Sestamibi in 66%. For the identification of the affected vessels, the results of TI-201 were sensitivity 56%, specificity 84% and accuracy 64%, and those of Sestamibi 61%, 89% and 73%, respectively. These data confirm the results of previous comparative studies and indicate that Sestamibi is slightly superior to TI-201 in current clinical routine.
Abstracts Tuesday afternoon, April 20, 1999
$71
35.40
99mTc-Sestamibi SPECT: Combination of pharmacologic and exercise stress is superior to pharmacologic stress S.Gr6ber, H.Vogt, G.Graf, P.Heidenreich. Klinik fiJr Nuklearmedizin, Zentralklinikum Augsburg, Germany The results of pharmacologic stress with 0.56 m 9 dipyridamoleper kg body-weight were compared with a combined dipyridamole & exercise stress protocol. In 200 pts unable to exercise adequately myocardial scintigraphy was done with a three-headed Picker camera equipped with fan - beam collimators. The acquired data were processed by applying the so called simultaneous transmission and emission protocol (STEP). Results: pharm, stress comb. stress
LAD sens. spec. 73% 65% 90% 81%
RCX sens. spec. 79% 75% 85% 83%
RCA sens. spec. 69% 86% 92% 86%
Conclusion: In p.ts who are unable to exercise adequately a combination of pharmacologic and exercise stress is superior to pharmacologic stress in determination of extent and severity of coronary artery disease. The combined stress protocol is as safe and inexpensive as the pure dipyridamole stress protocol.
T U E S D A Y P M
35.39
35.41
H Y P E R T E N S I V E BLOOD P R E S S U R E R E S P O N S E TO EXERCISE AND ISCHEMIC ST-T SEGMENT CHANGES: CORRELATION WITH MYOCARDIAL PERFUSION SCINTIGRAPHY S.Kirac,F.J.Th. Wackers.Yale University. New Haven, CT
QUALITY OF LIFE 7 YEARS AFTER EXERCISE THALLIUM SPECT J.Milavetz, T.Miller, D.Hodge, R.Gibbons. Mayo Clinic, Rochester, Minnesota, USA.
The mechanism and significance of ischemic-appearing (false-positive) electrocardiographic ST-T segment changes to exercise are unclear. We hypothesized that in selected patients (pts) this may be due to nontransmural ischemia caused by hypertensive blood pressure (BP) response, not detectable by exercise myocardial perfusion imaging (MPI). We evaluated the association between hypertensive BP response to exercise (systolic BP >_180 and diastolic BP >_ 95 mmHg) and ischemic ST-T segment changes in 217 pts with normal exercise MPI. 128 pts (61%) had ischemic ST-T segment changes on the exercise ECG; 89 pts (39%) had normal exercise ECG. 130 pts (60%) had hypertensive BP response, 87 pts (40%) had normal BP response to exercise. There were no significant differences between the two groups for age,sex, risk factors for coronary artery disease and hemodynamic parameters on exercise. Patients with ischemie ST-T segment changes did not have a significantly greater prevalence of hypertensive BP response compared to pts with normal ST-T segment during exercise (62% vs 57%). This was also true when multiple other cut-off levels for hypertensive BP response were analyzed. Conclusion: In patients with normal exercise MPI, ischemic-appearing ST-T segment changes are not significantly associated with hypertensive BP response. Thus, ischemic ECG changes can not be explained by demand-nontransmural ischemia undetected by myocardial perfusion images.
Exercise T 1-SPECT has been shown to predict survival and cardiac events, but whether it can predict quality of life (QOL) is unknown. 2,253 patients (59+10 years, 1,264 male; 989 female) who had undergone an exercise T1-SPECT 7.3_+0.9 years earlier ranked their perceived general health (PGH) among 5 levels ("excellent" to "poor") and ranked their perceived cardiac abilities (PCA) among 4 levels ("can do anything" to "have trouble doing almost anything"). A summed reversibility score (SRS) was assigned for abnormal scans to determine ischemia extent and severity. Patients with normal (n=1,244) and abnormal (n=l,009) scans did not differ with respect to PGH (p=0.342), but did significantly differ with respect to PCA (p<0.001). Of 622 pts reporting excellent PCA, 403 (65%) had normal scans. SRS was not associated with PGH (p=0.63) but was associated with PCA (p<0.001). In conclusion, T 1-SPECT appears to predict PCA but not PGH during long-term follow up.
A P R I L 20