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Evaluation of patients with end stage cardiac insufficiency before and after cardiomioplasty by radionuclide angiocardiography
$84
Abstracts Tuesday afternoon, April 25, 1995
P16-333
P16-335
M Y O C A R D I A L INDIUM-111 A N T I M Y O S I N UPTAKE AFTER UNCOMPLICATED C O R O N A R Y A R T E R Y BYPASS S U R G E R Y
EVALUATION OF PATIENTS WITH END STAGE CARDIAC INSUFFICIENCY BEFORE AND AFTER CARDIOMIOPI_ASTY BY RADIONUCLIDE ANGIOCARDIOGRAPHY. G.Calsamiglia, G.Cannizzaro, M. Rinaldi, C.Aprile. - Fondazione Cliniea Lavoro - Montescano (Pavia) - Italy -
Ettore Astorri, Giovanni Andrea Contini, Paolo Fiorina, Annalisa Astorri, Gilberto Gavaruzzi*, Cattedre di Cardiologia e di Cardiochirurgia, Universil~ di Parma, *Servizio Medicina Nucleare, USL n. 4 Parma, Italy
T U E S D A Y
JOURNAL OF NUCLEARCARDIOLOGY March/April 1995, Part 2
Indium 111 monoclonal antimyosin antibody scintigraphy has been shown to be highly sensitive ann specific for even very small areas of myocardial necrosis or sufferance. Uptake of this radio tracer was evaluated after coronary surgery (CABG) in 14 unformed and consenting consecutive patients without previous myocardial infarction, with uncomplicated surgical procedure and postoperative course, who underwent CABG for stable angina pectoris. Indium- 111 monoclonal anti myosin antibody (74 MBq Myoscint9 Centocor) was injected on third post-operative day; planar images in anterior, left anterior oblique 45 ~ and 70~ projections were obtained 24 and 48 hours later and analysed for myocardial uptake. Indium-I 11 anti myosin uptake was present in 10 out of 14 patients (71.4%); it was diffuse in 6 and localised in 4. The ratio of the maximal counts in the myocardium to the counts of adjacent lung background (HA, ratio) was measured and found elevated (1.94_+0.36). No good relation was observed between Indium-ll 1 antimyosin uptake or H/L ratio and Creatine kinase-MB isoenzyme (19_+15 ng/ml), AST (44+18 mU/ml) levels, duration of cardiopulmonaly bypass or aortic cross-clamp time and ST-T changes on ECG, while elevated serum myosin 13 heavy chain fragments (IRMA, Pasteur| were observed (1378_+238ng/ml). This preliminary study suggests that some degree of myocardial damage, though silent, is common after CABG.
Dynamic cardiomioplasty (CMP) is a new surgical procedure consisting in a long term elettrostimulation of a latissimus dorsi muscle wrapped around the failing heart. We evaluated by muitiple gated acquisition (MUGA) 10 males pts.(3 ischemic and 7 idiopathic cardiomiopathy; range 39-60 years). All pts. were evaluated before the CMP (TO), 8 at 6 ,7 at 12 months T1 T2 TO Left Vent.Ejection Fraction 29,5_+9,3 i LVEF in assisted cycles 24,1+11,4 27,9+12,2 LVEF without elettrostim. 26,2_+11,.4 25,6_+11,8 Peak Ejection Rate 1,15_+0,5 1,17_+0,6 1,24_+0,4 Peak Filling Rate 0,99_-+0,4 0,86_+0,4 0,84_-+0,1 There were no significant differences for variables considered before and after CMP. Follow up (NYHA functional class): 6 months 2 death 4 unchanged 4 improved 12 months 1 death 3unchanged 3 mproved Conclusions: good MUGA studies were obtained in all pts. despite difficulties in R wave synchronization; even if 6/7 pts. improved their NYHA class no significant modification was observed either in the systolic or in the dyastolic function at 6 and 12 months.
P M A P R I L
P 16-334
P16-336
DOES REST-REDISTRIBUTION THALLIUM-201 IMAGING PREDICT IMPROVEMENT IN LEFT VENTRICULAR FUNCTION AFTER AORTO-CORONARY BY-PASS SURGERY ?
T H A L L I U M - 199 S C I N T I G R A P H Y - IN EVALUATION OF CORONARY ARTERY DISEASE REVASCULARISATION
C Leblebici, V Sansoy, D Gezelsoy. Institute of Cardiology, University of Istanbul, Istanbul, Turkey.
Yu.Lishmanov, J.Vesnina, V.Chernov, A.Chernyavskiy, S h . A k h m e d o v , V.Pekarskiy. T o m s k Institute o f Cardiology, Russia
To test the hypothesis that rest-redistribution quantitative TI-201 imaging (RTI) would identify viable myocardium and predict improved myocardial function after coronary by-pass surgery (CBS) in patients with coronary artery disease (CAD), we studied 20 patients (mean EF: 0.27) before and 10 weeks after CBS by radiunuclide ventriculography and RTI. On the basis of quantitative analysis of defect severity, all segments showing more than 50% TI uptake on late images were consideredviable. By RTI criteria 84% of asynergie segments wore found to be viable. Sixty-one percent of viable segments functionally improved postoperatively, whereas only 36% of nonviable segments improved (p<0.03). When only adequately revascularized segments wore considered, the predictive value of a positive preoperative viability scan for functional improvement was 94%. The greatest improvement in global left ventricular function (LVF) after CBS occurred in patients with the greatest number of adequately revascularized asynergic segments classified as viable before surgery, In conclusion, preoperative RTI identifies viability in many asynergic segments in patients with CAD and depressed LVF and these segmentsfrequently improve function after CBS.
A i m o f this study was the scintigraphic e v a l u a t i o n of myocardial revascularisation in patients (pts) with c o r o n a r y artery disease ( C A D ) a n d myocardial infarction ( M I ) u n d e r w e n t the cardiomyoplasty ( C M P ) or c o r o n a r y bypass surgery (CBS) using short life nuclide 199T1 (T!/2=7.4h).37 C A D pts a n d 26 M I pts with successful t r o m b o l i t i c therapy u n d e r w e n t CBS. 18 pts with large left ventricular aneurysm u n d e r w e n t C M P .All the pts were investigated by means o f d y p i r i d a m o l e 199T1 scintigraphy before 1 a n d 12 m o n t h s after operation. It was demonstrated, t h a t CBS a n d C M P lead to considerable decrease in reversible defect size in all g r o u p o f pts. In M I pts after CBS decrease in persistent defect size was d e m o n s t r a t e d . After C M P we f o u n d reduction in 199T1 lung uptake. Those, 199T1 myocardial scintigraphy is an objective study for d y n a m i c evaluation myocardial perfusion after surgery treatment.
Abstracts Tuesday afternoon, April 25, 1995
P16-333
P16-335
M Y O C A R D I A L INDIUM-111 A N T I M Y O S I N UPTAKE AFTER UNCOMPLICATED C O R O N A R Y A R T E R Y BYPASS S U R G E R Y
EVALUATION OF PATIENTS WITH END STAGE CARDIAC INSUFFICIENCY BEFORE AND AFTER CARDIOMIOPI_ASTY BY RADIONUCLIDE ANGIOCARDIOGRAPHY. G.Calsamiglia, G.Cannizzaro, M. Rinaldi, C.Aprile. - Fondazione Cliniea Lavoro - Montescano (Pavia) - Italy -
Ettore Astorri, Giovanni Andrea Contini, Paolo Fiorina, Annalisa Astorri, Gilberto Gavaruzzi*, Cattedre di Cardiologia e di Cardiochirurgia, Universil~ di Parma, *Servizio Medicina Nucleare, USL n. 4 Parma, Italy
T U E S D A Y
JOURNAL OF NUCLEARCARDIOLOGY March/April 1995, Part 2
Indium 111 monoclonal antimyosin antibody scintigraphy has been shown to be highly sensitive ann specific for even very small areas of myocardial necrosis or sufferance. Uptake of this radio tracer was evaluated after coronary surgery (CABG) in 14 unformed and consenting consecutive patients without previous myocardial infarction, with uncomplicated surgical procedure and postoperative course, who underwent CABG for stable angina pectoris. Indium- 111 monoclonal anti myosin antibody (74 MBq Myoscint9 Centocor) was injected on third post-operative day; planar images in anterior, left anterior oblique 45 ~ and 70~ projections were obtained 24 and 48 hours later and analysed for myocardial uptake. Indium-I 11 anti myosin uptake was present in 10 out of 14 patients (71.4%); it was diffuse in 6 and localised in 4. The ratio of the maximal counts in the myocardium to the counts of adjacent lung background (HA, ratio) was measured and found elevated (1.94_+0.36). No good relation was observed between Indium-ll 1 antimyosin uptake or H/L ratio and Creatine kinase-MB isoenzyme (19_+15 ng/ml), AST (44+18 mU/ml) levels, duration of cardiopulmonaly bypass or aortic cross-clamp time and ST-T changes on ECG, while elevated serum myosin 13 heavy chain fragments (IRMA, Pasteur| were observed (1378_+238ng/ml). This preliminary study suggests that some degree of myocardial damage, though silent, is common after CABG.
Dynamic cardiomioplasty (CMP) is a new surgical procedure consisting in a long term elettrostimulation of a latissimus dorsi muscle wrapped around the failing heart. We evaluated by muitiple gated acquisition (MUGA) 10 males pts.(3 ischemic and 7 idiopathic cardiomiopathy; range 39-60 years). All pts. were evaluated before the CMP (TO), 8 at 6 ,7 at 12 months T1 T2 TO Left Vent.Ejection Fraction 29,5_+9,3 i LVEF in assisted cycles 24,1+11,4 27,9+12,2 LVEF without elettrostim. 26,2_+11,.4 25,6_+11,8 Peak Ejection Rate 1,15_+0,5 1,17_+0,6 1,24_+0,4 Peak Filling Rate 0,99_-+0,4 0,86_+0,4 0,84_-+0,1 There were no significant differences for variables considered before and after CMP. Follow up (NYHA functional class): 6 months 2 death 4 unchanged 4 improved 12 months 1 death 3unchanged 3 mproved Conclusions: good MUGA studies were obtained in all pts. despite difficulties in R wave synchronization; even if 6/7 pts. improved their NYHA class no significant modification was observed either in the systolic or in the dyastolic function at 6 and 12 months.
P M A P R I L
P 16-334
P16-336
DOES REST-REDISTRIBUTION THALLIUM-201 IMAGING PREDICT IMPROVEMENT IN LEFT VENTRICULAR FUNCTION AFTER AORTO-CORONARY BY-PASS SURGERY ?
T H A L L I U M - 199 S C I N T I G R A P H Y - IN EVALUATION OF CORONARY ARTERY DISEASE REVASCULARISATION
C Leblebici, V Sansoy, D Gezelsoy. Institute of Cardiology, University of Istanbul, Istanbul, Turkey.
Yu.Lishmanov, J.Vesnina, V.Chernov, A.Chernyavskiy, S h . A k h m e d o v , V.Pekarskiy. T o m s k Institute o f Cardiology, Russia
To test the hypothesis that rest-redistribution quantitative TI-201 imaging (RTI) would identify viable myocardium and predict improved myocardial function after coronary by-pass surgery (CBS) in patients with coronary artery disease (CAD), we studied 20 patients (mean EF: 0.27) before and 10 weeks after CBS by radiunuclide ventriculography and RTI. On the basis of quantitative analysis of defect severity, all segments showing more than 50% TI uptake on late images were consideredviable. By RTI criteria 84% of asynergie segments wore found to be viable. Sixty-one percent of viable segments functionally improved postoperatively, whereas only 36% of nonviable segments improved (p<0.03). When only adequately revascularized segments wore considered, the predictive value of a positive preoperative viability scan for functional improvement was 94%. The greatest improvement in global left ventricular function (LVF) after CBS occurred in patients with the greatest number of adequately revascularized asynergic segments classified as viable before surgery, In conclusion, preoperative RTI identifies viability in many asynergic segments in patients with CAD and depressed LVF and these segmentsfrequently improve function after CBS.
A i m o f this study was the scintigraphic e v a l u a t i o n of myocardial revascularisation in patients (pts) with c o r o n a r y artery disease ( C A D ) a n d myocardial infarction ( M I ) u n d e r w e n t the cardiomyoplasty ( C M P ) or c o r o n a r y bypass surgery (CBS) using short life nuclide 199T1 (T!/2=7.4h).37 C A D pts a n d 26 M I pts with successful t r o m b o l i t i c therapy u n d e r w e n t CBS. 18 pts with large left ventricular aneurysm u n d e r w e n t C M P .All the pts were investigated by means o f d y p i r i d a m o l e 199T1 scintigraphy before 1 a n d 12 m o n t h s after operation. It was demonstrated, t h a t CBS a n d C M P lead to considerable decrease in reversible defect size in all g r o u p o f pts. In M I pts after CBS decrease in persistent defect size was d e m o n s t r a t e d . After C M P we f o u n d reduction in 199T1 lung uptake. Those, 199T1 myocardial scintigraphy is an objective study for d y n a m i c evaluation myocardial perfusion after surgery treatment.