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Comparison of Stress-Reinjection Thallium scintigraphy and stress-rest technetium - 99m SestaMIBI scintigraphy with or without nitrates potentiation. In assessment of patients with previous myocardial infarction
Journal of Nuclear Cardiology Volume 6, Number 1, Part 2
Abstracts Tuesday morning, April 20, 1999
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EXERCISE-REST Tc-99m TETROFOSMIN SPECT IN PATIENTS WITH ISCHEMIC LEFT VENTRICULAR DYSFUNCTION: DIRECT COMPARISON WITH THALLIUM-201 REINJECTION. E. Nicolai, A. Cuocolo, W. Acampa, A. Varrone, L. Pace, M. Salvatore. University Federico II, Napoli, Italy. The results of exercise-rest Tc-99m tetrofbsmin SPECT and those of thallium-201 reinjection at rest after exercise-redistribution imaging were compared in 33 patients with chronic myocardial infarction and left ventricular (LV) dysfunction. Tracers activity was quantitatively measured in 22 segments/patient. LV function was assessed in corresponding segments by echocardiography. Agreement in the evaluation of regional perfusion status between tetrofosmin and thallium was observed in 78% of the 726 total segments (k=.61). In segments with normal function (n=436), no difference between thallium and tetrofosmin uptake was observed, in hypokinetic segments (n=138), exercise tetrofosmin uptake was lower (p<.01) as compared to exercise thallium activity, while no difference was observed between tetrofosmin uptake at rest as compared to thallium activity on redistribution and reinjection images. In akinetic or dyskinetic segments (n=152), tetrofosmin uptake on exercise images was reduced (p<.01) as compared to exercise thallium activity; furthermore, tetrofosmin uptake at rest was lower (p<.01) as compared to thallium activity on both redistribution and reinjection images. In these segments, concordance in the detection of myocardial viability between tetrofosmin and thallium was observed in 138 (91%) of the 152 segments (k=.77). In conclusion, in patients with ischemic LV dysfunction quantitative exercise-rest tetrotbsmin and thallium reinjection SPECT provide similar information in the assessment of perfusion status and in the detection of myocardial viability.
Comparison o f S t r e s s - R e i n j e c t i o n Thallium S c i n t i g r a p h y and S t r e s s - R e s t T e c h n e t i u m 9 9 m SestaMIBI S c i n t i g r a p h y With or W i t h o u t Nitrates Potentiation. In A s s e s s m e n t of P a t i e n t s with Previous Myocardial Infarction. A.Allam, G.Nasr, H.Shab, H.EIGindy, M.Mansour, S.Shaker, M.Salama, F.Maklady. AL-AZHAR Uni., Cairo, EGYPT.
23.54 COMPARISON BETWEEN NITRATE ENHANCED TC-99M S E S T A M I B I A N D T H A L L I U M 201 U P T A K E FOR T H E D E T E C T I O N OF V I A B L E M Y O C A R D I U M 1N I S C H A E M I C C A R D I O M Y O P A T H Y . R Senior, S Kaul, U Raval, A Lahiri. Northwick Park Hospital, Harrow. UK Controversy exists regarding the relative value of Tc-99m sestamibi (MIBI) compared to thallium-201 (T1) imaging for the prediction of viable myocardium in patients with ischaemic cardiomyopathy. Accordingly, 56 consecutive patients with ischaemic cardiolnyopathy (LVEF-24±10%) nnder~ent both nitrate enhanced rest MIBI and TI S P E C T on scparate davs. Viable mvocardium was defined as normal or mildly reduced systolic wall thickening or dobutamine (dob) enhanced or deterioration of contractility o f severely d3synergic seglnents during cchocardiography, lsotopc uptake was assessed qualitatively, (grade 0=norlnal to grade 4=absent). MIBI and T1 scores were 1.2±1.1 and 1.1+1.2 respectively (p=NS) in viable segments and 2.4±1.2 and 2.3±1.3 (p=NS) respectively in the non-viable segments Thus, both nitrate enhanced MIBI and TI showed similar uptake in viable and non-viable segments in patients with ischaelnic cardiomyopathy.
Fifty p a t i e n t s (pts) with p r e v i o u s MI u n d e r w e n t StressRe-injection T h a l l i u m (T1), s t r e s s - r e s t SestaMIBI (TcS) and rest SestaMIBI with Nitrates (Ntr) potentiation (NTcS). Age 51 + 9 yrs, 49 pts were males, risk factors 1.7 + 1.1, c h e s t pain 1 5 / 5 0 pts. Twenty nine anterior, 15 inferior a n d 6 lateral MI. EF% in 4 4 / 5 0 pts was 37.6 + 8.9%. Reversible defect (RD) 7.7 + 3 ÷+ vs 6.14 _+ 3 vs 5.9 _+ 2.7 ++P<0.002, reversibility index 8.7 _+ 4.2 ÷÷ vs 6.4 + 3 vs 6.7 + 4.9 +÷P<0.005, fixed defects 3 _+ 2.7 +÷ vs 3.8 +_ 3.4 vs 3.9 _+ 2.8 ÷+P<0.04 s i m u l t a n e o u s l y in T1 vs TcS vs N-TcS (++P vs TcS and N-TcS). In 24 pts with EF>35% RD 8.5 + 3.1 ++ vs 6.8 +_ 2.8 vs 6.5 _+ 2.7 ++P<0.03. While, in the 20 pts with EF = or <35% RD 6.9 + 3 *÷ vs 4.8 + 3.2 vs 5 _+ 2.8 ÷+P<0.04 s i m u l t a n e o u s l y in T1 vs TcS vs N-TcS. Thus, T1 is s u p e r i o r TcS a n d N-TcS in detection of reversibility in pts with p r e v i o u s MI, w h e t h e r or not pts has LV dysfunction. Ntr potentiation does not solve the problem of u n d e r e s t i m a t i o n of reversibility.
23.56 DIFFERENCE OF TI-201 UPTAKE BETWEEN REDISTRIBUTION AND REST IS A SPECIFIC MARKER OF MYOCARDIAL VIABILITY Dziuk M., CSK WAM Hospital> Warsaw, Poland A l t h o u g h TI-201 rest redistribution S P E C T is widely used to assess myocardial viability there is no a g r e e m e n t what is the best prognostic marker o f left ventricle (LV) contractility improvement after revascularization. 25 patients with L V dyssynergy w e r e studied b e f o r e and after revascularization with T I - 2 0 t S P E C T and echocardiography. L V was divided into 16 segments. Perfusion and contractility was assessed semiquantitativety in 97 dysfunctional segments. Only the modulus o f difference b e t w e e n rest and redistribution study (which includes reversibility as well as reverse redistribution) _> 10% was the only c o m m o n parameter for hypo-, a- and dyskinetic segments to predict the functional r e c o v e r y o f L V with the specificity o f 9 3 % and sensitivity o f 81%. Conclusion: The modulus o f segmental quantitative difference b e t w e e n redistribution and rest image _> 10 is a n e w parameter adding specificity to TI-201 rest redistibution S P E C T in prediction o f r e c o v e r y o f L V function.
Abstracts Tuesday morning, April 20, 1999
$51
23.53
23.55
EXERCISE-REST Tc-99m TETROFOSMIN SPECT IN PATIENTS WITH ISCHEMIC LEFT VENTRICULAR DYSFUNCTION: DIRECT COMPARISON WITH THALLIUM-201 REINJECTION. E. Nicolai, A. Cuocolo, W. Acampa, A. Varrone, L. Pace, M. Salvatore. University Federico II, Napoli, Italy. The results of exercise-rest Tc-99m tetrofbsmin SPECT and those of thallium-201 reinjection at rest after exercise-redistribution imaging were compared in 33 patients with chronic myocardial infarction and left ventricular (LV) dysfunction. Tracers activity was quantitatively measured in 22 segments/patient. LV function was assessed in corresponding segments by echocardiography. Agreement in the evaluation of regional perfusion status between tetrofosmin and thallium was observed in 78% of the 726 total segments (k=.61). In segments with normal function (n=436), no difference between thallium and tetrofosmin uptake was observed, in hypokinetic segments (n=138), exercise tetrofosmin uptake was lower (p<.01) as compared to exercise thallium activity, while no difference was observed between tetrofosmin uptake at rest as compared to thallium activity on redistribution and reinjection images. In akinetic or dyskinetic segments (n=152), tetrofosmin uptake on exercise images was reduced (p<.01) as compared to exercise thallium activity; furthermore, tetrofosmin uptake at rest was lower (p<.01) as compared to thallium activity on both redistribution and reinjection images. In these segments, concordance in the detection of myocardial viability between tetrofosmin and thallium was observed in 138 (91%) of the 152 segments (k=.77). In conclusion, in patients with ischemic LV dysfunction quantitative exercise-rest tetrotbsmin and thallium reinjection SPECT provide similar information in the assessment of perfusion status and in the detection of myocardial viability.
Comparison o f S t r e s s - R e i n j e c t i o n Thallium S c i n t i g r a p h y and S t r e s s - R e s t T e c h n e t i u m 9 9 m SestaMIBI S c i n t i g r a p h y With or W i t h o u t Nitrates Potentiation. In A s s e s s m e n t of P a t i e n t s with Previous Myocardial Infarction. A.Allam, G.Nasr, H.Shab, H.EIGindy, M.Mansour, S.Shaker, M.Salama, F.Maklady. AL-AZHAR Uni., Cairo, EGYPT.
23.54 COMPARISON BETWEEN NITRATE ENHANCED TC-99M S E S T A M I B I A N D T H A L L I U M 201 U P T A K E FOR T H E D E T E C T I O N OF V I A B L E M Y O C A R D I U M 1N I S C H A E M I C C A R D I O M Y O P A T H Y . R Senior, S Kaul, U Raval, A Lahiri. Northwick Park Hospital, Harrow. UK Controversy exists regarding the relative value of Tc-99m sestamibi (MIBI) compared to thallium-201 (T1) imaging for the prediction of viable myocardium in patients with ischaemic cardiomyopathy. Accordingly, 56 consecutive patients with ischaemic cardiolnyopathy (LVEF-24±10%) nnder~ent both nitrate enhanced rest MIBI and TI S P E C T on scparate davs. Viable mvocardium was defined as normal or mildly reduced systolic wall thickening or dobutamine (dob) enhanced or deterioration of contractility o f severely d3synergic seglnents during cchocardiography, lsotopc uptake was assessed qualitatively, (grade 0=norlnal to grade 4=absent). MIBI and T1 scores were 1.2±1.1 and 1.1+1.2 respectively (p=NS) in viable segments and 2.4±1.2 and 2.3±1.3 (p=NS) respectively in the non-viable segments Thus, both nitrate enhanced MIBI and TI showed similar uptake in viable and non-viable segments in patients with ischaelnic cardiomyopathy.
Fifty p a t i e n t s (pts) with p r e v i o u s MI u n d e r w e n t StressRe-injection T h a l l i u m (T1), s t r e s s - r e s t SestaMIBI (TcS) and rest SestaMIBI with Nitrates (Ntr) potentiation (NTcS). Age 51 + 9 yrs, 49 pts were males, risk factors 1.7 + 1.1, c h e s t pain 1 5 / 5 0 pts. Twenty nine anterior, 15 inferior a n d 6 lateral MI. EF% in 4 4 / 5 0 pts was 37.6 + 8.9%. Reversible defect (RD) 7.7 + 3 ÷+ vs 6.14 _+ 3 vs 5.9 _+ 2.7 ++P<0.002, reversibility index 8.7 _+ 4.2 ÷÷ vs 6.4 + 3 vs 6.7 + 4.9 +÷P<0.005, fixed defects 3 _+ 2.7 +÷ vs 3.8 +_ 3.4 vs 3.9 _+ 2.8 ÷+P<0.04 s i m u l t a n e o u s l y in T1 vs TcS vs N-TcS (++P vs TcS and N-TcS). In 24 pts with EF>35% RD 8.5 + 3.1 ++ vs 6.8 +_ 2.8 vs 6.5 _+ 2.7 ++P<0.03. While, in the 20 pts with EF = or <35% RD 6.9 + 3 *÷ vs 4.8 + 3.2 vs 5 _+ 2.8 ÷+P<0.04 s i m u l t a n e o u s l y in T1 vs TcS vs N-TcS. Thus, T1 is s u p e r i o r TcS a n d N-TcS in detection of reversibility in pts with p r e v i o u s MI, w h e t h e r or not pts has LV dysfunction. Ntr potentiation does not solve the problem of u n d e r e s t i m a t i o n of reversibility.
23.56 DIFFERENCE OF TI-201 UPTAKE BETWEEN REDISTRIBUTION AND REST IS A SPECIFIC MARKER OF MYOCARDIAL VIABILITY Dziuk M., CSK WAM Hospital> Warsaw, Poland A l t h o u g h TI-201 rest redistribution S P E C T is widely used to assess myocardial viability there is no a g r e e m e n t what is the best prognostic marker o f left ventricle (LV) contractility improvement after revascularization. 25 patients with L V dyssynergy w e r e studied b e f o r e and after revascularization with T I - 2 0 t S P E C T and echocardiography. L V was divided into 16 segments. Perfusion and contractility was assessed semiquantitativety in 97 dysfunctional segments. Only the modulus o f difference b e t w e e n rest and redistribution study (which includes reversibility as well as reverse redistribution) _> 10% was the only c o m m o n parameter for hypo-, a- and dyskinetic segments to predict the functional r e c o v e r y o f L V with the specificity o f 9 3 % and sensitivity o f 81%. Conclusion: The modulus o f segmental quantitative difference b e t w e e n redistribution and rest image _> 10 is a n e w parameter adding specificity to TI-201 rest redistibution S P E C T in prediction o f r e c o v e r y o f L V function.