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7.40 Dobutamine tc-sestamibi gated SPECT: prediction of ventricular function improvement in patients undergoing coronary bypass grafting
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Abstracts Friday, M a y 4, 2001
7.37 Dobutamine stress echocardiography versus FDG SPECT for assessment of viable myocardium: influence of second harmonic imaging. FB Sozzi, J Bax 1, D Poldermans, WB Vletter, E Vourvouri, E Boersma, A Borghetti, A Elhendy, R Valkema, JRTC Roelandt. Cardiology ThoraxCenter Rotterdam, 1Cardiology Leiden University Medical School Leiden Netherlands. FDG imaging has been consistently demonstrated to be more sensitive than dobutamine stress echocardingmphy (DSE) for the detection of viability. Besides pathophysiologic aspects, this can also be related to suboptimal endocardial border visualization. Second harmonic imaging (SHI) has been demonstrated superior for endocardial border detection as compared to fundamental imaging (FI). Thus, we compared FDG SPECT and DSE using FI and SHI for the assessment of viability in 30 patients with ischemic cardiomyopathy. Dysfunctional rayocardium was considered viable in the presence of normal perfusion/FDG uptake or reduced perfusion with relatively increased FDG uptake. Dysfunctional segments were considered viable on DSE when they exhibited contractile reserve or demonstrated immediate worsening of wall motion during dobutamine infusion (up to 40 mcg/kg/min with atropine). 329 segments were severely dysfunctional on DSE using FI, with 199 being viable on FDG SPECT. Agreement for viability between FDG SPECT and DSE was 72%, for nonviability 85% and overall agreement was 78%. Using SHI, 294 segments were severely dysfunctional, with 158 being viable on FDG SPECT. The agreement between FDG SPECT and DSE for viability was 87%, for nonviability 86% and the overall agreement was 87%. Thus, sensitivity of DSE for detection of viability can be enhanced using SHI.
F R I D A
Journal of Nuclear Cardiology J a n u a r y / F e b r u a r y 2001
7.39 Impact of attenuation correction on evaluation of myocardial perfusion using a dual-isotope TI-201 (rest) and Tc-99m sestamibi (stress) protocol. JO Prior, G Storto, A BischofDelaloye.NuclearMedicineCHUVLausanneSwitzerland. Background: Attenuation correction (AC) in myocardial gated single-phototi emission computed tomography (GS), using a dual-isotope protocol, has not yet been entirely investigated. We evaluated the impact of AC on myocardial perfusion in patients (pts) with suspected coronary artery disease. Methods: We performed TI-201 rest (111MBq) and Tc-99m Sestamibi stress (900MBq) myocardial GS in 90 consecutive pts (41W, 49M, aged 65-4-10y). Images were acquired on a dual-head camera (Siemens E-Cam) equipped with Gd-153 sources and processed using, filtered back projection for non-corrected (NC) and iterative reconstruction for corrected images. Short-axis images were qualitatively evaluated and quantitative analysis was performed by dividing the let~ ventricular wall into 21 segments. Segmental activity was normalized in NC and AC studies, for both rest and stress. We divided a total of 1890 segments, according to the degree of reduction in normalized activity, for both tracers, in three groups: (A) segments with a small reduction of activity (>=80% of max., n=946/1042 TI-201/Tc-99m Sestamibi); (B) moderate reduction (>=50% to <80% n=883/779); (C) severe reduction (<50%, n=61/69). Statistical analysis used the two-sided matched sample sign test with a significance level of (p<0.05). Results: (Table 1). Group C was too small to produce statistically significant results. Conclusion: AC compensates for attenuation artifacts in septal and inferior regions, but not in apical, lateral and anterior ones, both for TI-201 and Tc-99m, when there is a low reduction in relative activity. The use of AC shows an overcorrection of moderate reduction of activity, for both radionuclides, in anterior, septal and inferior wall leading to possible underestimation of perfusion defects. MyocardialRegion A (>-80%) B (>=50& <80%) C (<50%) Apex AC < NC * n.s. n.s. Anterior AC < NC * AC > NC * n.s. Septum AC > NC * AC > NC * n.s. Inferior AC > NC * AC > NC * n.s. Lateral AC < NC * n.s. n.s. Segmentalnormalizedcorrected(AC)and non-corrected(NC) activityfor TI-201and Tc-99m Sestainibi accordingto perfusion reduction.(n.s.--notstatistically significant, *=13<0.05)
Y M A Y
7.38 The effect of exercise-induced ischaemia on left-ventricular function and regional wall motion on post-stress gated myocardial perfusion tomogram with 99m Te-Q12. I Vassiliadis, A Foantos 1, K Oimas1, A Sideris 1, P. Chaikos. Cardiac Dept. Athiuai Navy Hospital Kifisia, Athens, 1 Euroclinic Athens Greece. The sequential assessment of left ventricular function (LVEF) and myocardial perfnsion with quantitative gated SPECT (QGS) is a usefull tool in evaluating pts with CAD. Published data demonstrated differences in relative values of post stress LVEF (SEF) and rest LVEF(REF), explained either as measurement error or as postischemic stunning.. The purpose of our study was to investigate whether post-stress LVEF represents basal resting LVEF or is influenced by exerciseinduced ischemia. Twenty-six conseeutive pts with known or suspected CAD, underwent a same-day stress/rest QGS using 99m Tc-Q12 (Furifosmin). Cedars QGS® technique was used to calculate LVEF. The series of post-stress and rest images were read for presence, location, severity and reversibility of the perfnsion defects and were correlated to regional contraction abnormalities and LVEF values changes. Gating was successful in both studies in 24 pts. Nineteen pts had abnormal QGS. In 5(26%) of 19 pts with reversible defects, post-exercise LVEF was>5% lower than that at rest, 10(53%) revealed an LVEF equal or grater than that at rest and the remaining 4(21%) bad fixed defects. Segmental wall motion analysis showed that the depression in global LV function was due to regional asynergy in the territories of the reversible perfnsion defects. Our data suggest that in pts with exercise-induced ischemia, LVEF derived fi'om the post-stress images of the QGS cannot be considered to represent basal LVEF as far as postischemic stunning could be operative.
7.40 Dobutamine tc-sestamibi gated SPECT: prediction of ventricular function improvement in patients undergoing coronary bypass grafting. N Zafrir, T Ben-Gal I, A Arditi2, A Caspi 2, A Battler 1. Nuclear Cardiology Rabin Medical Center Petah Tikva Israel, 1 Rabin Medical Center Petah Tikva, 2 Kaplan Medical Center Rehovot Israel. Background: Dobutamine Tc - sestamibi gated SPECT enables us to assess myocardial viability concomitantly by perfusion and contractile reserve of the same myocardial segments. The predictive value of this method was evaluated in patients with ischemic cardiomyopathy who underwent CABG. Methods: Thirty-four patients with triple-vessel disease and mean LVEF of 25+/5% underwent viability assessment within one month prior to CABG. All were injected with 30 mci of Tc sesmmibi. Gated SPECT was performed at rest and during infusion of 5 to 10 mkg/kg/min of dobutamine. The processing was performed according to the 20 segments model using 4-grade scoring for perfusion as well as for wall motion (0-normal perfusion or wall motion to 3 severely reduced uptake 50% or less) or akinesis/dyskinesis) and contractile reserve. Repeated resting Gated SPECT was performed within 12 months after CABG. Results: Of 420 myocardial segments studied (septal segments were excluded) there were 310 (74%) showed wall motion abnormality. Of these 158 (51%) segments were viable by perfusion versus 128 (41%) segments by contractile reserve (p<0.05). The predictive values of wall motion improvement after CABG by perfusion and by contractile reserve were: Accuracy: 77% versus 80%, positive predictive value: 72% versus 87%, negative predictive value: 87% versus 73% respectively. Conclusion: Dobutamine sestamibi gated SPECT is a useful method for prediction of wall motion improvement in patients with ischemic cardiomyopathy who are candidate for CABG. The concomitant assessment of perfusion and contractile reserve using one technique may provide the preferable predictive values.
Abstracts Friday, M a y 4, 2001
7.37 Dobutamine stress echocardiography versus FDG SPECT for assessment of viable myocardium: influence of second harmonic imaging. FB Sozzi, J Bax 1, D Poldermans, WB Vletter, E Vourvouri, E Boersma, A Borghetti, A Elhendy, R Valkema, JRTC Roelandt. Cardiology ThoraxCenter Rotterdam, 1Cardiology Leiden University Medical School Leiden Netherlands. FDG imaging has been consistently demonstrated to be more sensitive than dobutamine stress echocardingmphy (DSE) for the detection of viability. Besides pathophysiologic aspects, this can also be related to suboptimal endocardial border visualization. Second harmonic imaging (SHI) has been demonstrated superior for endocardial border detection as compared to fundamental imaging (FI). Thus, we compared FDG SPECT and DSE using FI and SHI for the assessment of viability in 30 patients with ischemic cardiomyopathy. Dysfunctional rayocardium was considered viable in the presence of normal perfusion/FDG uptake or reduced perfusion with relatively increased FDG uptake. Dysfunctional segments were considered viable on DSE when they exhibited contractile reserve or demonstrated immediate worsening of wall motion during dobutamine infusion (up to 40 mcg/kg/min with atropine). 329 segments were severely dysfunctional on DSE using FI, with 199 being viable on FDG SPECT. Agreement for viability between FDG SPECT and DSE was 72%, for nonviability 85% and overall agreement was 78%. Using SHI, 294 segments were severely dysfunctional, with 158 being viable on FDG SPECT. The agreement between FDG SPECT and DSE for viability was 87%, for nonviability 86% and the overall agreement was 87%. Thus, sensitivity of DSE for detection of viability can be enhanced using SHI.
F R I D A
Journal of Nuclear Cardiology J a n u a r y / F e b r u a r y 2001
7.39 Impact of attenuation correction on evaluation of myocardial perfusion using a dual-isotope TI-201 (rest) and Tc-99m sestamibi (stress) protocol. JO Prior, G Storto, A BischofDelaloye.NuclearMedicineCHUVLausanneSwitzerland. Background: Attenuation correction (AC) in myocardial gated single-phototi emission computed tomography (GS), using a dual-isotope protocol, has not yet been entirely investigated. We evaluated the impact of AC on myocardial perfusion in patients (pts) with suspected coronary artery disease. Methods: We performed TI-201 rest (111MBq) and Tc-99m Sestamibi stress (900MBq) myocardial GS in 90 consecutive pts (41W, 49M, aged 65-4-10y). Images were acquired on a dual-head camera (Siemens E-Cam) equipped with Gd-153 sources and processed using, filtered back projection for non-corrected (NC) and iterative reconstruction for corrected images. Short-axis images were qualitatively evaluated and quantitative analysis was performed by dividing the let~ ventricular wall into 21 segments. Segmental activity was normalized in NC and AC studies, for both rest and stress. We divided a total of 1890 segments, according to the degree of reduction in normalized activity, for both tracers, in three groups: (A) segments with a small reduction of activity (>=80% of max., n=946/1042 TI-201/Tc-99m Sestamibi); (B) moderate reduction (>=50% to <80% n=883/779); (C) severe reduction (<50%, n=61/69). Statistical analysis used the two-sided matched sample sign test with a significance level of (p<0.05). Results: (Table 1). Group C was too small to produce statistically significant results. Conclusion: AC compensates for attenuation artifacts in septal and inferior regions, but not in apical, lateral and anterior ones, both for TI-201 and Tc-99m, when there is a low reduction in relative activity. The use of AC shows an overcorrection of moderate reduction of activity, for both radionuclides, in anterior, septal and inferior wall leading to possible underestimation of perfusion defects. MyocardialRegion A (>-80%) B (>=50& <80%) C (<50%) Apex AC < NC * n.s. n.s. Anterior AC < NC * AC > NC * n.s. Septum AC > NC * AC > NC * n.s. Inferior AC > NC * AC > NC * n.s. Lateral AC < NC * n.s. n.s. Segmentalnormalizedcorrected(AC)and non-corrected(NC) activityfor TI-201and Tc-99m Sestainibi accordingto perfusion reduction.(n.s.--notstatistically significant, *=13<0.05)
Y M A Y
7.38 The effect of exercise-induced ischaemia on left-ventricular function and regional wall motion on post-stress gated myocardial perfusion tomogram with 99m Te-Q12. I Vassiliadis, A Foantos 1, K Oimas1, A Sideris 1, P. Chaikos. Cardiac Dept. Athiuai Navy Hospital Kifisia, Athens, 1 Euroclinic Athens Greece. The sequential assessment of left ventricular function (LVEF) and myocardial perfnsion with quantitative gated SPECT (QGS) is a usefull tool in evaluating pts with CAD. Published data demonstrated differences in relative values of post stress LVEF (SEF) and rest LVEF(REF), explained either as measurement error or as postischemic stunning.. The purpose of our study was to investigate whether post-stress LVEF represents basal resting LVEF or is influenced by exerciseinduced ischemia. Twenty-six conseeutive pts with known or suspected CAD, underwent a same-day stress/rest QGS using 99m Tc-Q12 (Furifosmin). Cedars QGS® technique was used to calculate LVEF. The series of post-stress and rest images were read for presence, location, severity and reversibility of the perfnsion defects and were correlated to regional contraction abnormalities and LVEF values changes. Gating was successful in both studies in 24 pts. Nineteen pts had abnormal QGS. In 5(26%) of 19 pts with reversible defects, post-exercise LVEF was>5% lower than that at rest, 10(53%) revealed an LVEF equal or grater than that at rest and the remaining 4(21%) bad fixed defects. Segmental wall motion analysis showed that the depression in global LV function was due to regional asynergy in the territories of the reversible perfnsion defects. Our data suggest that in pts with exercise-induced ischemia, LVEF derived fi'om the post-stress images of the QGS cannot be considered to represent basal LVEF as far as postischemic stunning could be operative.
7.40 Dobutamine tc-sestamibi gated SPECT: prediction of ventricular function improvement in patients undergoing coronary bypass grafting. N Zafrir, T Ben-Gal I, A Arditi2, A Caspi 2, A Battler 1. Nuclear Cardiology Rabin Medical Center Petah Tikva Israel, 1 Rabin Medical Center Petah Tikva, 2 Kaplan Medical Center Rehovot Israel. Background: Dobutamine Tc - sestamibi gated SPECT enables us to assess myocardial viability concomitantly by perfusion and contractile reserve of the same myocardial segments. The predictive value of this method was evaluated in patients with ischemic cardiomyopathy who underwent CABG. Methods: Thirty-four patients with triple-vessel disease and mean LVEF of 25+/5% underwent viability assessment within one month prior to CABG. All were injected with 30 mci of Tc sesmmibi. Gated SPECT was performed at rest and during infusion of 5 to 10 mkg/kg/min of dobutamine. The processing was performed according to the 20 segments model using 4-grade scoring for perfusion as well as for wall motion (0-normal perfusion or wall motion to 3 severely reduced uptake 50% or less) or akinesis/dyskinesis) and contractile reserve. Repeated resting Gated SPECT was performed within 12 months after CABG. Results: Of 420 myocardial segments studied (septal segments were excluded) there were 310 (74%) showed wall motion abnormality. Of these 158 (51%) segments were viable by perfusion versus 128 (41%) segments by contractile reserve (p<0.05). The predictive values of wall motion improvement after CABG by perfusion and by contractile reserve were: Accuracy: 77% versus 80%, positive predictive value: 72% versus 87%, negative predictive value: 87% versus 73% respectively. Conclusion: Dobutamine sestamibi gated SPECT is a useful method for prediction of wall motion improvement in patients with ischemic cardiomyopathy who are candidate for CABG. The concomitant assessment of perfusion and contractile reserve using one technique may provide the preferable predictive values.