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Correlations of hemodynamic effects with myocardial perfusion SPECT sestamibi images during arbutamine infusion
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W E D N E S D A Y P M A P R I L
Abstracts Wednesday morning, April 26, 1995
JOURNAL OF NUCLEAR CARDIOLOGY March/April 1995, Part 2
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DOBUTAMINE STRESS HAS LIMITED VALUE FOR ENHANCING FLOW HETEROGENEITY IN THE PRESENCE OF A MODERATE STENOSIS: IMPLICATIONS FOR TC99H-SESTAMIBI IMAGING JJ Yun, JC Wu, EN Heller, L Deckelbaum, DP Dione, YH Liu, FJTh Wackers, AJ Sinusas. Yale Univ., New Haven CT, USA Dobutamine (DUB} is used in conjunction with Tc99msestamibi (MB) imaging to produce flow {FL) hetergeneity. TO validate this pharmacological approach, we injected MB and radiolabeled microspheres (MS) in 6 open chest dogs during peak DOB stress {i0 ~g/kg/min) in the presence of a moderate (30 m ~ g gradient) LCX stenosis {STEN). MS were also injected at baseline (EASE), and during STEN Pre-DOB. Hearts were excised 20 min after MB injection, and cut into 96 or 192 segments for ganm~ well counting, for determination of MB activity and MS F L Coronary FL reserve in response to i.e. adenosine (18Zg) was 2.44• at BASE and 1.24• during STEN (p<0.05}. DOB increased heart rate (Pre-DOB:ll2• DOB:141• P<0.05), but did not change mean aortic pressure (Pre-DOB:80• DOB:95• p-ns). FL (ml/min/gm) and MB for nonischemic (NI) and ischemic (IS) regions were: (mean++SEM) IS FL NI FL IS/NI FL IS/NI M~ BASE 0.88+0,13 0.96• 0.93~0.02 --STEN 0.58f0.14 0,97• 0.59• --DUB 1.02i0.37 1.87• 0.5290.12# 0.70• ^ *p<0.05 vs STEN; #p-ns vs STEN; ^p<0.05 vs IS/NI EL DUB increased FE in both NI and IS regions. MB correlated with FL (MB-0.69FL+0.47,r=0.66) when FL was less than 1 ml/min/gm. At higher FL (i to 4.8 ml/min/gm) MB did not correlate with FL (MB=0.04FL+0.94, r-0.13). MB underestimated the FL deficit. Thus, DUB MB imaging may be of limited value, since (i) DOS does not augment FL heterogeneity in the presence of a moderate STEN, and (2) M B d o e s not correlate with FL at the higher FL induced by DUB.
W H O L E BODY E X E R C I S E T H A L L I U M I M A G I N G 1N HEAVY SMOKERS AND P A T I E N T S W I T H CORONARY A R T E R Y DISEASE Ph~ sDe Telher Christophe vasseur Dommioue Calhn MarieHelene Bourdrei Centre de Medecine Nuciealre me I'Artols Arras France
Whole body exercise thallium scintigraphy can detect silent i n t e r e x t r e m i t y a s y m m e t r y in a b o u t 60% of patients with coronary a r t e r y disease.The aim of this study was to determine the influence of age, smoking and coronary a r t e r y disease on the d i s t r i b u t i o n of thallium 201 at the level o f legs in 138 p a t i e n t s . In group 1 were included 14 heavy smokers ( more than 28 pack years ) with (n=51) or w i t h o u t coronary artery disease ln=23) anti in group 2 64 non smokers without coronary a r t e r y disease. I n t e r g r o u p comparison was made by Student's test for nonpaired serles, Patients of group I w e r e older than patients of group 2 ( 58_+9 versus 47.6_+II years, p
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CORRELATIONS OF HEMODYNAMIC EFFECTS WITH MYOCARDIAL PERFUSION SPECT SESTAMIBI IMAGES DURING ARBUTAMINE INFUSION
P R O G N O S T I C VALUE OF H I G H D O S E D I P Y R I D A M O L E 9 9 M TC S E S T A M I B I S P E T IN U R E M I C P A T I E N T S W I T H O U T C A R D I A C SIGNS, S Y M P T O M S A N D D I A B E T E S ON THE WAITING LIST FOR RENAL TRANSPLANT.
J. David Ogilby, Jeffrey G. Kegel, Jeffrey H. Johnson, Joanne Reilley, Virginia Cave, Jaekyeong Heo, Abdulmassih S. Iskandrian, Philadelphia Heart Institute, Philadelphia, PA.
A.DE BERARDINIS, M.BACCEGA, W.MARTINY, R.ROPOLO, A.TORTORE, G.SEGOLONI, G.SQUICCIMARRO, M.CANPANA P.G.DE FILIPPI, M.CASACCIA.OSPEDALE NOLINETTE T O R I N O , ITALIA.
Hemodynamic effects of arbutamine (ARB), using a closed-loop delivery system, were studied in 14 pts with chest pain syndrome in the catheterization laboratory. The HR, aortic and pulmonary pressures, LV dP/dT, and thermodilution cardiac output (CO) were measured at baseline, peak stress, and during reeovery. Results: Coronary angiography showed >50% stenosis in 8 pts (Gpl) and 0-49% in 6 pts (Gp2). During ARB infusion, the 14 pts had a HR J" from 76:s to 115 • beats/rain (p=0.0001), aortic systolic pressure $ from 149:t:20 to 121+29 mmHg (p=0.0009), PCW mean $ from 13• to 9• mmHg (p=0.0022), LV dP/dT 1" from 1296• to 2357• mmHg/see (p=0.0001), and Total SVR $ from 1372• to 713a:278 dynes-sec-cm 4 (p=0.0001). In Gpl pts, cardiac output 1" from 6.3• to 9.2• L/min at peak ARB effect (p=0.0004). In Gp2 pts, COJ" from 7.4• to 12,2• L/rain at peak ARB effect (p=0.0047). Gp2 demonstrated a greater ~ in CO at peak ARB effect than Gpl (p=0.032). 8 pts in Gpl developed angina during ARB (p<0.002) but no significant ECG changes, Sestamibi scan was abnormal in 6/8 pts in Gpl and 1/6 pts in Gp2. Conclusions: ARe produces significant chronotropic (1" HR), inotropie (1" CO and LV dP/dT), and vasodilatory (4, Total SVR) effects in patients with and without CAD.
C o r o n a r y a r t e r y d i s e a s e (CAD) is the m a j o r c a u se O f m o r b i d i t y a n d m o r t a l i t y in c h r o n i c h a e m o d i a l y s i s a n d r e n a l t r a n s p l a n t (RT) p a t i e n t s ( p t s ) We e v a l u a t e d the p r o g n o s t i c s i g n i f i c a n c e o f myocardial per•177 imaging with high dose dipyrid a m o l e (DPM) 9 9 m T c S e s t a m i b i (MIBI). 121 c o n s e c u t i v e p t s on the w a i t i n g l i s t for RT w i t h o u t c a r d i a c s y m p t o m s and d i a b e t e s , m o r e t h a n 55 y e a r s o l d or 5 y e a r s of h a e m o d i a l y s i s w e r e p e r f o r m e d in 2 d i f f e r e n t d a y s w i t h i n 24 h o u r s from last dialythic treatment. Mean follow-up was 1 8 . 8 • months. G R O U P l ( n o r m a l scan) G R O U P 2 ( a b n o r m a l ) pts 93 28 RT 7 4 events 1 7 Probability of cardiac events: G R O U P 1 =6%; G R O U P 2 1 1 - 4 5 % . p : O . 0 0 1 ( c o n f i d e n c e i n t e r v a l 95%) C o n c l u s i o n : t h i s s t u d y c o n f i r m the p r o g n o s t i c v a l u e a n d the u s e f u l n e s s o f h i g h d o s e D P M M I B I S P E T in s c r e e n i n g l o w r i s k s u b j e c t s on the waiting list for renal transplant.
W E D N E S D A Y P M A P R I L
Abstracts Wednesday morning, April 26, 1995
JOURNAL OF NUCLEAR CARDIOLOGY March/April 1995, Part 2
$48-349
$48-351
DOBUTAMINE STRESS HAS LIMITED VALUE FOR ENHANCING FLOW HETEROGENEITY IN THE PRESENCE OF A MODERATE STENOSIS: IMPLICATIONS FOR TC99H-SESTAMIBI IMAGING JJ Yun, JC Wu, EN Heller, L Deckelbaum, DP Dione, YH Liu, FJTh Wackers, AJ Sinusas. Yale Univ., New Haven CT, USA Dobutamine (DUB} is used in conjunction with Tc99msestamibi (MB) imaging to produce flow {FL) hetergeneity. TO validate this pharmacological approach, we injected MB and radiolabeled microspheres (MS) in 6 open chest dogs during peak DOB stress {i0 ~g/kg/min) in the presence of a moderate (30 m ~ g gradient) LCX stenosis {STEN). MS were also injected at baseline (EASE), and during STEN Pre-DOB. Hearts were excised 20 min after MB injection, and cut into 96 or 192 segments for ganm~ well counting, for determination of MB activity and MS F L Coronary FL reserve in response to i.e. adenosine (18Zg) was 2.44• at BASE and 1.24• during STEN (p<0.05}. DOB increased heart rate (Pre-DOB:ll2• DOB:141• P<0.05), but did not change mean aortic pressure (Pre-DOB:80• DOB:95• p-ns). FL (ml/min/gm) and MB for nonischemic (NI) and ischemic (IS) regions were: (mean++SEM) IS FL NI FL IS/NI FL IS/NI M~ BASE 0.88+0,13 0.96• 0.93~0.02 --STEN 0.58f0.14 0,97• 0.59• --DUB 1.02i0.37 1.87• 0.5290.12# 0.70• ^ *p<0.05 vs STEN; #p-ns vs STEN; ^p<0.05 vs IS/NI EL DUB increased FE in both NI and IS regions. MB correlated with FL (MB-0.69FL+0.47,r=0.66) when FL was less than 1 ml/min/gm. At higher FL (i to 4.8 ml/min/gm) MB did not correlate with FL (MB=0.04FL+0.94, r-0.13). MB underestimated the FL deficit. Thus, DUB MB imaging may be of limited value, since (i) DOS does not augment FL heterogeneity in the presence of a moderate STEN, and (2) M B d o e s not correlate with FL at the higher FL induced by DUB.
W H O L E BODY E X E R C I S E T H A L L I U M I M A G I N G 1N HEAVY SMOKERS AND P A T I E N T S W I T H CORONARY A R T E R Y DISEASE Ph~ sDe Telher Christophe vasseur Dommioue Calhn MarieHelene Bourdrei Centre de Medecine Nuciealre me I'Artols Arras France
Whole body exercise thallium scintigraphy can detect silent i n t e r e x t r e m i t y a s y m m e t r y in a b o u t 60% of patients with coronary a r t e r y disease.The aim of this study was to determine the influence of age, smoking and coronary a r t e r y disease on the d i s t r i b u t i o n of thallium 201 at the level o f legs in 138 p a t i e n t s . In group 1 were included 14 heavy smokers ( more than 28 pack years ) with (n=51) or w i t h o u t coronary artery disease ln=23) anti in group 2 64 non smokers without coronary a r t e r y disease. I n t e r g r o u p comparison was made by Student's test for nonpaired serles, Patients of group I w e r e older than patients of group 2 ( 58_+9 versus 47.6_+II years, p
$48-350
$49-352
CORRELATIONS OF HEMODYNAMIC EFFECTS WITH MYOCARDIAL PERFUSION SPECT SESTAMIBI IMAGES DURING ARBUTAMINE INFUSION
P R O G N O S T I C VALUE OF H I G H D O S E D I P Y R I D A M O L E 9 9 M TC S E S T A M I B I S P E T IN U R E M I C P A T I E N T S W I T H O U T C A R D I A C SIGNS, S Y M P T O M S A N D D I A B E T E S ON THE WAITING LIST FOR RENAL TRANSPLANT.
J. David Ogilby, Jeffrey G. Kegel, Jeffrey H. Johnson, Joanne Reilley, Virginia Cave, Jaekyeong Heo, Abdulmassih S. Iskandrian, Philadelphia Heart Institute, Philadelphia, PA.
A.DE BERARDINIS, M.BACCEGA, W.MARTINY, R.ROPOLO, A.TORTORE, G.SEGOLONI, G.SQUICCIMARRO, M.CANPANA P.G.DE FILIPPI, M.CASACCIA.OSPEDALE NOLINETTE T O R I N O , ITALIA.
Hemodynamic effects of arbutamine (ARB), using a closed-loop delivery system, were studied in 14 pts with chest pain syndrome in the catheterization laboratory. The HR, aortic and pulmonary pressures, LV dP/dT, and thermodilution cardiac output (CO) were measured at baseline, peak stress, and during reeovery. Results: Coronary angiography showed >50% stenosis in 8 pts (Gpl) and 0-49% in 6 pts (Gp2). During ARB infusion, the 14 pts had a HR J" from 76:s to 115 • beats/rain (p=0.0001), aortic systolic pressure $ from 149:t:20 to 121+29 mmHg (p=0.0009), PCW mean $ from 13• to 9• mmHg (p=0.0022), LV dP/dT 1" from 1296• to 2357• mmHg/see (p=0.0001), and Total SVR $ from 1372• to 713a:278 dynes-sec-cm 4 (p=0.0001). In Gpl pts, cardiac output 1" from 6.3• to 9.2• L/min at peak ARB effect (p=0.0004). In Gp2 pts, COJ" from 7.4• to 12,2• L/rain at peak ARB effect (p=0.0047). Gp2 demonstrated a greater ~ in CO at peak ARB effect than Gpl (p=0.032). 8 pts in Gpl developed angina during ARB (p<0.002) but no significant ECG changes, Sestamibi scan was abnormal in 6/8 pts in Gpl and 1/6 pts in Gp2. Conclusions: ARe produces significant chronotropic (1" HR), inotropie (1" CO and LV dP/dT), and vasodilatory (4, Total SVR) effects in patients with and without CAD.
C o r o n a r y a r t e r y d i s e a s e (CAD) is the m a j o r c a u se O f m o r b i d i t y a n d m o r t a l i t y in c h r o n i c h a e m o d i a l y s i s a n d r e n a l t r a n s p l a n t (RT) p a t i e n t s ( p t s ) We e v a l u a t e d the p r o g n o s t i c s i g n i f i c a n c e o f myocardial per•177 imaging with high dose dipyrid a m o l e (DPM) 9 9 m T c S e s t a m i b i (MIBI). 121 c o n s e c u t i v e p t s on the w a i t i n g l i s t for RT w i t h o u t c a r d i a c s y m p t o m s and d i a b e t e s , m o r e t h a n 55 y e a r s o l d or 5 y e a r s of h a e m o d i a l y s i s w e r e p e r f o r m e d in 2 d i f f e r e n t d a y s w i t h i n 24 h o u r s from last dialythic treatment. Mean follow-up was 1 8 . 8 • months. G R O U P l ( n o r m a l scan) G R O U P 2 ( a b n o r m a l ) pts 93 28 RT 7 4 events 1 7 Probability of cardiac events: G R O U P 1 =6%; G R O U P 2 1 1 - 4 5 % . p : O . 0 0 1 ( c o n f i d e n c e i n t e r v a l 95%) C o n c l u s i o n : t h i s s t u d y c o n f i r m the p r o g n o s t i c v a l u e a n d the u s e f u l n e s s o f h i g h d o s e D P M M I B I S P E T in s c r e e n i n g l o w r i s k s u b j e c t s on the waiting list for renal transplant.