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Low-dose dobutamine radionuclide angiography predicts improvement of function observed in viable myocardium after coronary revascularization
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
Abstracts Wednesday morning, April 9, 1997
84.40
84.42
SESTAMIBI SCINTIGRAPHY FOR EVALUATION OF TRANSMYOCARDIAL LASER REVASCULARIZATION (TMLR) - PRELIMEqARY RESULTS. T Grtining, J Kropp. S Wiener. WG Franke, B W~itzig, S Schiller. Dept Nuclear Medicine, University of Dresden, Germany
REVASCULARIZATION OF VIABLE MYOCARDIUM F A V O U R A B L Y I N F L U E N C E S L O N G TERM OUTCOME OF PATIENTS WITH END-STAGE ISCHEMIC LEFT VENTRICULAR DYSFUNCTION. A. Gimelli, P. Marzullo. CNR Clinical Physiology, Pisa, Italy on behalf of the VIP Study, Working Group on Nuclear Cardiology and Magnetic Resonance, ESC.
TMLR is a novel treatment in patients with coronary artery disease. It comprises the creation of transmyocardial channels during open heart surgery. To assess TMLR induced perfusion changes gated Tc-99m sestamibi scans were carried out after stress and at rest prior to and 1, 3, 6, and 12 months after treatment. Perfusion of lased segments was compared to that of reference segments.
$93
We found two different patterns of perfusion changes: a temporarily improved perfusion at I month after TMLR (A) and a steadily declining pcrfusion (B). These results need to be confirmed in a larger number of patients.
Little is know about the effect of coronary revascularization in patients with end-stage left ventrieular dysfunction. To this aim 53 patients (50 male, mean age 60+_7 yrs) with documented coronary artery disease and angiographic ejection fraction <.25 were followed-up for an average of 24-+11 months. Twenty patients were revascularized (group 1) either by angioplasty (11 patients) or by-pass graft (9 patients) and 33 were treated medically (group 2). The 2 groups were matched for age, ejection fraction, number of diseased vessels and number of dyssynergic segments. Both groups showed a similar uptake of Thallium-201 in dyssynergic areas (62~:20 vs 57_+18% of the peak, p=ns for all values). During the follow-up, eventfree survival was 100% in patients of group 1 while 5 patients of group 2 died of cardiac causes and t had non fatal myocardial infarction (event rate 21%). In conclusion, in patients with severe ischemic left ventricular dysfunction, revascularization significantly improved long-term outcome. In these patients, revascularization of viable, dysfunctioning myocardium represents a reliable alternative to orthotopic heart transplantation.
84.41
84.43
DETECTION OF RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY BY DOBUTAMINE MIBI SPECT IMAGING.
AbdouELheudy,MarcelL Geleijnse,Ron T van Domburg, Jos RTC Roelandt, Jan H Cornel, Galal M El-Said, M Mobsen Ibrahim, Medhat El-Reface, Peter R Nierop, Paolo M Fioretti. Thoraxcenter, and Departmentof Nuclear Medicine, Rotterdam,The Netherlands.
LOW-DOSE DOBUTAMINE RADIONUCLIDE ANGIOGRAPHY PREDICTS IMPROVEMENT OF FUNCTION OBSERVED IN VIABt.E MYOCARDIUM AFrER CORONARY REVASCULARIZATION. A. Gimelli, P. Marzullo. CNR Clinical Physiology, Pisa, Italy on behalf of the VIP Study, Working Group on Nuclear Cardiology and Magnetic Resonance, ESC.
Non invasiveevaluationof patients after PTCA is importantfor the detection of restenosis and selection of patients for coronary augiography.The role of dobutamineperfusionscintigraphyin this clinical setting has not been studied. Methods. We studied 40 patients with limited exercise capacity 185 ± 80 days after successful PTCA with high dose dobutamine(up to 40 #g/kg/min) stress test in conjunction with 99m technetium MIBI SPECT. Significant restenosis was defined as >50% luminal diameter stenosis. Results. Reversible perfnsion defects occurred in the distributionof 20 of 29 arteries with and in 4 of 17 arteries without restenosis. The sensitivityof dobutamine MIBI for the detectionof restenosis in arteries with previous PTCA was 69%; CI 56-82, specificity = 76%; CI 64-89 and accuracy = 72%; CI 59-85. Overall sensitivityof MIBI SPECT for the diagnosisof significant coronary stenosis (including arteries without previous PTCA) on patient basis was 79%; C167-92, specificity = 82%; C170-94, and accuracy = 80%; CI 68-92. Sensitivityof MIBI SPECT was higher than electrocardiography(79% vs 38%, p<0.005). Conclusion. DobutamineMIBI SPECT is a useful method for the detectionof restenosisafter PTCA in patients unable to perform an adequate exercise stress testing.
In patients with iscbemic left ventricular dysfunction, little is known about the response of global systolic and diastolic parameters to coronary revascularization. To this aim, we studied 12 patients (1 female, mean age 59_+8 yrs) with previous myocardial infarction and an ejection fraction ( E F ) below .40 by rest/dobutamine (5-10 mcg/Kg/min) radionuclide angiography. An average of 1.8 vessel per patient was successfully revascularized by angioplasty or surgery in 7 and 5 patients, respectively. Follow-up studies were obtained 4 weeks after revascularization. EF at rest was .28_+.9, increased at .36_+.12 during dobutamine (p<.01) and was .37___.10 at follow-up study (p=ns vs dobutamine). Similarly, PFR averaged 2.2+ t .3, 2.9+_1.7 and 3.1+_1.6 EDV/see in the same conditions (p values as EF). End-diastolic volume was reduced by 9% during dobutamine and by 14% at follow-up study. In conclusion, in patients with ischemic left ventricular dysfunction associated to maintained viability, improvement of function can be predicted by low-dose dobutamine radionuclide angiography. The prediction of global parameters allows the preoperative selection of patients in whom a significant improvement of ventricular dynamics is expected.
Regional nwocardial perfusion after TMLR (before=100) GrOup stress Rest lmo. 3 6 12 l m o . I 3 [ 6 112
t, ts(n)[ (10) 1 ( 1 0 ) 1 ( 7 ) 1 ( I ) 1 ( 1 0 ) i ( 1 0 ) 1 ( 7 ) 1 ( I ) all
/
A(6) ]
BCS)/
1071 971 961 l l 5 l 1221 I001 1041 115[ 801 81t 771 - [
101l 911 941 92 1111 97 / 1031 92 771 78/ 731 -
W E D N E S D A
Y A M A P R I
L 9
Abstracts Wednesday morning, April 9, 1997
84.40
84.42
SESTAMIBI SCINTIGRAPHY FOR EVALUATION OF TRANSMYOCARDIAL LASER REVASCULARIZATION (TMLR) - PRELIMEqARY RESULTS. T Grtining, J Kropp. S Wiener. WG Franke, B W~itzig, S Schiller. Dept Nuclear Medicine, University of Dresden, Germany
REVASCULARIZATION OF VIABLE MYOCARDIUM F A V O U R A B L Y I N F L U E N C E S L O N G TERM OUTCOME OF PATIENTS WITH END-STAGE ISCHEMIC LEFT VENTRICULAR DYSFUNCTION. A. Gimelli, P. Marzullo. CNR Clinical Physiology, Pisa, Italy on behalf of the VIP Study, Working Group on Nuclear Cardiology and Magnetic Resonance, ESC.
TMLR is a novel treatment in patients with coronary artery disease. It comprises the creation of transmyocardial channels during open heart surgery. To assess TMLR induced perfusion changes gated Tc-99m sestamibi scans were carried out after stress and at rest prior to and 1, 3, 6, and 12 months after treatment. Perfusion of lased segments was compared to that of reference segments.
$93
We found two different patterns of perfusion changes: a temporarily improved perfusion at I month after TMLR (A) and a steadily declining pcrfusion (B). These results need to be confirmed in a larger number of patients.
Little is know about the effect of coronary revascularization in patients with end-stage left ventrieular dysfunction. To this aim 53 patients (50 male, mean age 60+_7 yrs) with documented coronary artery disease and angiographic ejection fraction <.25 were followed-up for an average of 24-+11 months. Twenty patients were revascularized (group 1) either by angioplasty (11 patients) or by-pass graft (9 patients) and 33 were treated medically (group 2). The 2 groups were matched for age, ejection fraction, number of diseased vessels and number of dyssynergic segments. Both groups showed a similar uptake of Thallium-201 in dyssynergic areas (62~:20 vs 57_+18% of the peak, p=ns for all values). During the follow-up, eventfree survival was 100% in patients of group 1 while 5 patients of group 2 died of cardiac causes and t had non fatal myocardial infarction (event rate 21%). In conclusion, in patients with severe ischemic left ventricular dysfunction, revascularization significantly improved long-term outcome. In these patients, revascularization of viable, dysfunctioning myocardium represents a reliable alternative to orthotopic heart transplantation.
84.41
84.43
DETECTION OF RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY BY DOBUTAMINE MIBI SPECT IMAGING.
AbdouELheudy,MarcelL Geleijnse,Ron T van Domburg, Jos RTC Roelandt, Jan H Cornel, Galal M El-Said, M Mobsen Ibrahim, Medhat El-Reface, Peter R Nierop, Paolo M Fioretti. Thoraxcenter, and Departmentof Nuclear Medicine, Rotterdam,The Netherlands.
LOW-DOSE DOBUTAMINE RADIONUCLIDE ANGIOGRAPHY PREDICTS IMPROVEMENT OF FUNCTION OBSERVED IN VIABt.E MYOCARDIUM AFrER CORONARY REVASCULARIZATION. A. Gimelli, P. Marzullo. CNR Clinical Physiology, Pisa, Italy on behalf of the VIP Study, Working Group on Nuclear Cardiology and Magnetic Resonance, ESC.
Non invasiveevaluationof patients after PTCA is importantfor the detection of restenosis and selection of patients for coronary augiography.The role of dobutamineperfusionscintigraphyin this clinical setting has not been studied. Methods. We studied 40 patients with limited exercise capacity 185 ± 80 days after successful PTCA with high dose dobutamine(up to 40 #g/kg/min) stress test in conjunction with 99m technetium MIBI SPECT. Significant restenosis was defined as >50% luminal diameter stenosis. Results. Reversible perfnsion defects occurred in the distributionof 20 of 29 arteries with and in 4 of 17 arteries without restenosis. The sensitivityof dobutamine MIBI for the detectionof restenosis in arteries with previous PTCA was 69%; CI 56-82, specificity = 76%; CI 64-89 and accuracy = 72%; CI 59-85. Overall sensitivityof MIBI SPECT for the diagnosisof significant coronary stenosis (including arteries without previous PTCA) on patient basis was 79%; C167-92, specificity = 82%; C170-94, and accuracy = 80%; CI 68-92. Sensitivityof MIBI SPECT was higher than electrocardiography(79% vs 38%, p<0.005). Conclusion. DobutamineMIBI SPECT is a useful method for the detectionof restenosisafter PTCA in patients unable to perform an adequate exercise stress testing.
In patients with iscbemic left ventricular dysfunction, little is known about the response of global systolic and diastolic parameters to coronary revascularization. To this aim, we studied 12 patients (1 female, mean age 59_+8 yrs) with previous myocardial infarction and an ejection fraction ( E F ) below .40 by rest/dobutamine (5-10 mcg/Kg/min) radionuclide angiography. An average of 1.8 vessel per patient was successfully revascularized by angioplasty or surgery in 7 and 5 patients, respectively. Follow-up studies were obtained 4 weeks after revascularization. EF at rest was .28_+.9, increased at .36_+.12 during dobutamine (p<.01) and was .37___.10 at follow-up study (p=ns vs dobutamine). Similarly, PFR averaged 2.2+ t .3, 2.9+_1.7 and 3.1+_1.6 EDV/see in the same conditions (p values as EF). End-diastolic volume was reduced by 9% during dobutamine and by 14% at follow-up study. In conclusion, in patients with ischemic left ventricular dysfunction associated to maintained viability, improvement of function can be predicted by low-dose dobutamine radionuclide angiography. The prediction of global parameters allows the preoperative selection of patients in whom a significant improvement of ventricular dynamics is expected.
Regional nwocardial perfusion after TMLR (before=100) GrOup stress Rest lmo. 3 6 12 l m o . I 3 [ 6 112
t, ts(n)[ (10) 1 ( 1 0 ) 1 ( 7 ) 1 ( I ) 1 ( 1 0 ) i ( 1 0 ) 1 ( 7 ) 1 ( I ) all
/
A(6) ]
BCS)/
1071 971 961 l l 5 l 1221 I001 1041 115[ 801 81t 771 - [
101l 911 941 92 1111 97 / 1031 92 771 78/ 731 -
W E D N E S D A
Y A M A P R I
L 9