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7.53 Improved identification of viable myocardium using second harmonic imaging during dobutamine stress testing: comparison with fluorine-18 fluorodeoxiglucose SPECT
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Abstracts F r i d a y , M a y 4, 2 0 0 1
7.53 Improved identification of viable myocardium using second harmonic imaging during dobutamine stress testing: comparison with fluorine-18 fluorodeoxiglucose SPECT. FB Sozzi, D Poldermans, JJ Box, E Vourvouri, E Boersma, A Borghetti1, JRTC Roelandt. Erasmus Medical Center Thoraxcenter Rotterdam Netherlands, 1Med. Nephrol. and Prev. Science Dept. Parma Italy.
F R I D A Y M A Y
Objective: To determine whether second harmonic imaging (SHI) can improve the accuracy of dobutamine stress echocardiograpby (DSE) for identification of viable myocardium. Patients and Methods: We studied 30 patients with chronic left ventricular dysfunction (mean age 60 4- 8; 22 male) by DSE (up to 40 pg/kg/min). Imaging was acquired at rest and during dobutamine stress using both fundamental imaging (FI) and SHI. All patients underwent dual-isotope simultaneous acquisition single photon emission computerized tomogmphy (DISA-SPECT) with technetium-99m tetrofosmin/18-finorodeoxiglucose (FDG) on a separate day. Myocardial segments with akinesis or severe hypokinesis at baseline were considered viable by DSE if these demonstrated a biphasic, sustained improvement or iscbemic response during stress. Myocardial viability was considered by DISA in the presence of mildly reduced perfusion or severe perfusion/metabolism mismatch. Results: The number of severe hypokinetic/akinetic segments at rest was 329 by FI and 294 by SHI. 44% of dyssynergic segments were considered viable by FI and 62% were considered viable by SHI (p = 0.02). The agreement between DSE and DISA was significantly higher with SHI (87%, kappa = 0.73) than with FI (78%, kappa = 0.56, p = 0.005). When DISA was regarded as a standard for myocardial viability, SHI had higher sensitivity (87% vs. 73%, p = 0.001) and accuracy (88% vs. 78%, p = 0.005) whereas specificity was not different (86% vs. 85%, p = ns). Conclusion: SHI improves the accuracy of DSE for identification of viable myocardium as compared to FI. The agreement between DSE and DISA-SPECT is higher by the use of SHI.
7.54 The extent of viable myocardium by sestamibi imaging predicts functional outcome after coronary revascularization in patients with ischaemic leftventricular dysfunction. W Acampa, E Nicolai, M Petrctta 1, D Bonaduce l, A Cuocolo. Nuclear Medicine University Federico II Napoli, 1internal Medicine University Federico Ii Napoli Italy. This study was designed to assess the role of technetiurm99m sestamibi cardiac tomography in predicting improvement of leit ventricular (LV) function aiter myocardial revasculafization in patients with chronic ischemic LV dysfunction. Sixty-seven consecutive patients with LV dysfunction (LV ejection fraction by radionuclide angiography 394-9%) related to previous myocardial infarction (>8 months) underwent within one week echocardiography, radiounclide angiography and resting sestamibi SPECT after nitrate administration (10 mg sublingual). Sestamibi distribution was measured in 13 segments/patient. Regional LV function was evaluated in corresponding segments by echocardiogmphy. Ecbocardiogmphy and radionuclida angiography were repeated 12 months aider revascularization to assess recovery of LV function. Optimal threshold cutoff to separate reversible from irreversible dysfunction was determined by receiver operating characteristic analysis. The best cutoff for identifying reversible LV dysfunction was 55% of scstamibi activity. After coronary revascularization, LV ejection fraction improved >5% in 34 patients (from 39-J-9% to 464.8%, p<0.01) and did not change in 33 patients (from 40~9% to 40a:10%, p=ns). A significant relationship between the number of akinctic or dyskinetic segments with preserved sestamibi uptake (>55% of peak activity) and revascularization-induced changes in LV ejection fraction was observed (p<0.02). The threshold of 3 akinetic or dyskinetic segments (23% of the total LV myocardium) with preserved sestamibi uptake was the cutoff point that maximized the predictive power for improvement of LV ejection fraction >5% (chi-square 6.51, p<0.01). At multivariate analysis, the extent of akinetic or dyskinetic myocardium with preserved sestamibi uptake was the best predictor of LV functional improvement alter revascularization (global chi-square 6.54, p<0.01). In conclusion, in patients with chronic myocardial infarction and LV dysfunction the extent of akinetic or dyskinetic myocardium with preserved sestamibi activity predicts improvement of global LV function after revascularizatiun procedures.
Journal of Nuclear Cardiology January/February 2001
7.55 Gated-SPECT scintigraphy for the prediction of recovery after surgical myocardial revascularization. M Mazzanti, G Cianci 1, D Gabrielli, C Silenzi, GP Pema, A Purcaro. Nuclear Cardiology Lancisi Hospital Ancona, 1Nuclear Medicine Luncisi Hospital Ancona Italy. Gated-SPECT (g-SPECT) allows the evaluation of stress perfusion and poststress (ps) left ventricular function (LVF) and it has demonstrated to be accurate for the identification of viable myocardium. Aim of the study is to verify if LVF parameters that is lefi ventricular (LV) ejection fraction (EF), wall motion abnormalities (WMA) and thickening (WT) are able to predict the recovery after surgical myocardial revaseularization (SMR) over the perfusion standard informations. Methods: Fortysix consecutive patients (pts) with coronary artery disease (CAD) and previous myocardial infarction (MI) under,vent multiple SMR. The infarct location was anterior (26 pts), inferior (16 pts) and anterior+inferior (4 pts). All pts performed pro- and post-SMR (three months after SMR) stress/rest Te-99m tetrofosmin g-SPECT scintigraphy using a double head camera (ADAC) equipped with AUTOQUANT software, following a double-day protocol. Adopting a 20-segment myocardial analysis, visual WMA/WT and related summed scores (WMS and WTS) were collected with conventional parameters: automated LV EF, summed stress score (SSS) and summed rest score (SRS). WMS, SSS and SRS resulted by a 5-point scale (0-~aormal) and WTS by a 4-poitu scale scoring systam(0=normal). In our database LV EF normal/abnormal cut-off resulted to be 0.45. WTS/WMS ratio was calculated as an index to measure the amount of viable myocardium. Results: we identified two groups: Group A (28 pts) which showed a recovery of global LV function with an increase of ps LV EF > 5 units after SMR and Group B (18 pts) without significant post-SMR ps LV EF modification. In Group A ps LV EF pre-SMR resulted 0.44±0.12, WMS 30.2±2.3, WTS 12.5±1.8. SSS was 22.1±2.2 and 8 pts (28%) showed SRS > 7 as definite amount of inducible ischemia. WTS/WMS ratio was 0.48-2-0.16. 26/28 pts (98°,4) had WTS/WMS ratio < 0.6.Group B revealed (vs Group A): ps LV EF pre-SMR 0.50±2,1 (p=O.03); WMS 28.2±3.1 (p=N.S.); WTS 18.5±2.7 (p=0.005) and 4 pts (22%) with SRS > 7 (p=N.S.). The WTS/WMS ratio was 0.83~0.24 (p=0.005). 1/18 pts (5.5%) showed WTS/WMS ratio < 0.6. Conclusions: g-SPECT functional parameters are able to identify viable myoeardium in pts with previous MI and multiple akinetic territories. WTS/WMS ratio is useful to predict the fimctional recovery after multiple SMR.
7.56 Relation between Q-waves and viable myocardium in patients with prior myocardial infarction and left-ventricular dysfunction. AN Kitsiou, C Stefanadis1, P Toutouzas 1. Cardiology Dept. Sismanogleio Hosp Athens, lcardiology Dept Athens University Hippokrateio Hosp. Athens Greece. Background: In patients with prior myocardial infarction and left ventricular dysfunction, it is important to assess myocardial viability to guide therapeutic strategies. This patient population most commonly exhibits Q waves on the 12lead electrocardiogram. We sought to investigate the relation between Q waves and myocardial viability in patients with prior myocardial infarction and left ventricular dysfunction. Methods: Thirty-one patients (mean age 61±10 yrs) with a history of myocardial infarction (> 6 months) and lePc ventficular dysfimction (mean LVEF=28±10%) underwent stress-redistribution-reinjection SPECT thallium. The distribution of thallium was visually assessed in 16 segments per patient. On the basis of the presence of Q waves, an infarction was considered septal when Q waves were present in leads V1 and V2, anteroseptal when present in leads V1 to V4, lateral when present in leads I, aV1, and V6, extensive anterior when present in leads V1 to V6, and infero-posterior when present in leads II, III, and aVf. Results: From a total of 496 myocardial regions analyzed, 230 (46%) were associated with Q waves. Among these 230 regions, 78 (34%) were viable by thallium scintigraphy and 152 were nonviable. Conclusion: These findings indicate that substantial myocardial viability may be present in myocardial regions associated with Q waves on the 12-lead electrocardiogram. Thus, patients with prior myocardial infarction and lef~ ventricular dysfunction should undergo further testing for myocardial viability assessment, despite the presence of Q waves on the 12-lead electrocardiogram.
Abstracts F r i d a y , M a y 4, 2 0 0 1
7.53 Improved identification of viable myocardium using second harmonic imaging during dobutamine stress testing: comparison with fluorine-18 fluorodeoxiglucose SPECT. FB Sozzi, D Poldermans, JJ Box, E Vourvouri, E Boersma, A Borghetti1, JRTC Roelandt. Erasmus Medical Center Thoraxcenter Rotterdam Netherlands, 1Med. Nephrol. and Prev. Science Dept. Parma Italy.
F R I D A Y M A Y
Objective: To determine whether second harmonic imaging (SHI) can improve the accuracy of dobutamine stress echocardiograpby (DSE) for identification of viable myocardium. Patients and Methods: We studied 30 patients with chronic left ventricular dysfunction (mean age 60 4- 8; 22 male) by DSE (up to 40 pg/kg/min). Imaging was acquired at rest and during dobutamine stress using both fundamental imaging (FI) and SHI. All patients underwent dual-isotope simultaneous acquisition single photon emission computerized tomogmphy (DISA-SPECT) with technetium-99m tetrofosmin/18-finorodeoxiglucose (FDG) on a separate day. Myocardial segments with akinesis or severe hypokinesis at baseline were considered viable by DSE if these demonstrated a biphasic, sustained improvement or iscbemic response during stress. Myocardial viability was considered by DISA in the presence of mildly reduced perfusion or severe perfusion/metabolism mismatch. Results: The number of severe hypokinetic/akinetic segments at rest was 329 by FI and 294 by SHI. 44% of dyssynergic segments were considered viable by FI and 62% were considered viable by SHI (p = 0.02). The agreement between DSE and DISA was significantly higher with SHI (87%, kappa = 0.73) than with FI (78%, kappa = 0.56, p = 0.005). When DISA was regarded as a standard for myocardial viability, SHI had higher sensitivity (87% vs. 73%, p = 0.001) and accuracy (88% vs. 78%, p = 0.005) whereas specificity was not different (86% vs. 85%, p = ns). Conclusion: SHI improves the accuracy of DSE for identification of viable myocardium as compared to FI. The agreement between DSE and DISA-SPECT is higher by the use of SHI.
7.54 The extent of viable myocardium by sestamibi imaging predicts functional outcome after coronary revascularization in patients with ischaemic leftventricular dysfunction. W Acampa, E Nicolai, M Petrctta 1, D Bonaduce l, A Cuocolo. Nuclear Medicine University Federico II Napoli, 1internal Medicine University Federico Ii Napoli Italy. This study was designed to assess the role of technetiurm99m sestamibi cardiac tomography in predicting improvement of leit ventricular (LV) function aiter myocardial revasculafization in patients with chronic ischemic LV dysfunction. Sixty-seven consecutive patients with LV dysfunction (LV ejection fraction by radionuclide angiography 394-9%) related to previous myocardial infarction (>8 months) underwent within one week echocardiography, radiounclide angiography and resting sestamibi SPECT after nitrate administration (10 mg sublingual). Sestamibi distribution was measured in 13 segments/patient. Regional LV function was evaluated in corresponding segments by echocardiogmphy. Ecbocardiogmphy and radionuclida angiography were repeated 12 months aider revascularization to assess recovery of LV function. Optimal threshold cutoff to separate reversible from irreversible dysfunction was determined by receiver operating characteristic analysis. The best cutoff for identifying reversible LV dysfunction was 55% of scstamibi activity. After coronary revascularization, LV ejection fraction improved >5% in 34 patients (from 39-J-9% to 464.8%, p<0.01) and did not change in 33 patients (from 40~9% to 40a:10%, p=ns). A significant relationship between the number of akinctic or dyskinetic segments with preserved sestamibi uptake (>55% of peak activity) and revascularization-induced changes in LV ejection fraction was observed (p<0.02). The threshold of 3 akinetic or dyskinetic segments (23% of the total LV myocardium) with preserved sestamibi uptake was the cutoff point that maximized the predictive power for improvement of LV ejection fraction >5% (chi-square 6.51, p<0.01). At multivariate analysis, the extent of akinetic or dyskinetic myocardium with preserved sestamibi uptake was the best predictor of LV functional improvement alter revascularization (global chi-square 6.54, p<0.01). In conclusion, in patients with chronic myocardial infarction and LV dysfunction the extent of akinetic or dyskinetic myocardium with preserved sestamibi activity predicts improvement of global LV function after revascularizatiun procedures.
Journal of Nuclear Cardiology January/February 2001
7.55 Gated-SPECT scintigraphy for the prediction of recovery after surgical myocardial revascularization. M Mazzanti, G Cianci 1, D Gabrielli, C Silenzi, GP Pema, A Purcaro. Nuclear Cardiology Lancisi Hospital Ancona, 1Nuclear Medicine Luncisi Hospital Ancona Italy. Gated-SPECT (g-SPECT) allows the evaluation of stress perfusion and poststress (ps) left ventricular function (LVF) and it has demonstrated to be accurate for the identification of viable myocardium. Aim of the study is to verify if LVF parameters that is lefi ventricular (LV) ejection fraction (EF), wall motion abnormalities (WMA) and thickening (WT) are able to predict the recovery after surgical myocardial revaseularization (SMR) over the perfusion standard informations. Methods: Fortysix consecutive patients (pts) with coronary artery disease (CAD) and previous myocardial infarction (MI) under,vent multiple SMR. The infarct location was anterior (26 pts), inferior (16 pts) and anterior+inferior (4 pts). All pts performed pro- and post-SMR (three months after SMR) stress/rest Te-99m tetrofosmin g-SPECT scintigraphy using a double head camera (ADAC) equipped with AUTOQUANT software, following a double-day protocol. Adopting a 20-segment myocardial analysis, visual WMA/WT and related summed scores (WMS and WTS) were collected with conventional parameters: automated LV EF, summed stress score (SSS) and summed rest score (SRS). WMS, SSS and SRS resulted by a 5-point scale (0-~aormal) and WTS by a 4-poitu scale scoring systam(0=normal). In our database LV EF normal/abnormal cut-off resulted to be 0.45. WTS/WMS ratio was calculated as an index to measure the amount of viable myocardium. Results: we identified two groups: Group A (28 pts) which showed a recovery of global LV function with an increase of ps LV EF > 5 units after SMR and Group B (18 pts) without significant post-SMR ps LV EF modification. In Group A ps LV EF pre-SMR resulted 0.44±0.12, WMS 30.2±2.3, WTS 12.5±1.8. SSS was 22.1±2.2 and 8 pts (28%) showed SRS > 7 as definite amount of inducible ischemia. WTS/WMS ratio was 0.48-2-0.16. 26/28 pts (98°,4) had WTS/WMS ratio < 0.6.Group B revealed (vs Group A): ps LV EF pre-SMR 0.50±2,1 (p=O.03); WMS 28.2±3.1 (p=N.S.); WTS 18.5±2.7 (p=0.005) and 4 pts (22%) with SRS > 7 (p=N.S.). The WTS/WMS ratio was 0.83~0.24 (p=0.005). 1/18 pts (5.5%) showed WTS/WMS ratio < 0.6. Conclusions: g-SPECT functional parameters are able to identify viable myoeardium in pts with previous MI and multiple akinetic territories. WTS/WMS ratio is useful to predict the fimctional recovery after multiple SMR.
7.56 Relation between Q-waves and viable myocardium in patients with prior myocardial infarction and left-ventricular dysfunction. AN Kitsiou, C Stefanadis1, P Toutouzas 1. Cardiology Dept. Sismanogleio Hosp Athens, lcardiology Dept Athens University Hippokrateio Hosp. Athens Greece. Background: In patients with prior myocardial infarction and left ventricular dysfunction, it is important to assess myocardial viability to guide therapeutic strategies. This patient population most commonly exhibits Q waves on the 12lead electrocardiogram. We sought to investigate the relation between Q waves and myocardial viability in patients with prior myocardial infarction and left ventricular dysfunction. Methods: Thirty-one patients (mean age 61±10 yrs) with a history of myocardial infarction (> 6 months) and lePc ventficular dysfimction (mean LVEF=28±10%) underwent stress-redistribution-reinjection SPECT thallium. The distribution of thallium was visually assessed in 16 segments per patient. On the basis of the presence of Q waves, an infarction was considered septal when Q waves were present in leads V1 and V2, anteroseptal when present in leads V1 to V4, lateral when present in leads I, aV1, and V6, extensive anterior when present in leads V1 to V6, and infero-posterior when present in leads II, III, and aVf. Results: From a total of 496 myocardial regions analyzed, 230 (46%) were associated with Q waves. Among these 230 regions, 78 (34%) were viable by thallium scintigraphy and 152 were nonviable. Conclusion: These findings indicate that substantial myocardial viability may be present in myocardial regions associated with Q waves on the 12-lead electrocardiogram. Thus, patients with prior myocardial infarction and lef~ ventricular dysfunction should undergo further testing for myocardial viability assessment, despite the presence of Q waves on the 12-lead electrocardiogram.