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Incremental diagnostic value of dobutamine stress echocardiography (DSE) and Tc-99m MIBI-SPECT for detection of coronary artery disease (CAD)
JOURNAL OF NUCLEARCARDIOLOGY Volume 2, Number 2, Part 2
Abstracts Tuesday morning, April 25, 1995
P07-169
P07-171
NON-IMAGING ANGIOCARDIOGRAPHIC MONITORING (CARDIOSCINTTM) AND ECOCARDIOGRAPHYFOR EVALUATING LEFT VENTRICULAR FUNCTIONIN PATIENTSWITH CORONARY ARTERY DISEASE. PRELIMINARYDATA.
Tc-99m SPET TETROFOSMIN VS TI-201 SPET REST/ REDISTRIBUTION AND DOBUTAMINE ECHO IN VIABILITY ASSESSMENT AFTER AMI IN SINGLE VESSEL CAD
Carla Silenzi,Nino Ciampani, Marco Mazzanti, Carlo Costantini, Giovann: Cianci, AugustoPurcaro. Lancisi Heart Hospital, Italy.
R.Benti, U.La Marchesina, A.Finzi, G.Marotta, A.Bnmo, C.Canzi, M.Caslellani, E.Reschini, S.Perlini, C.Sdraiati, P.Gemndini. Nuclear Medicine Dept.- Ospedale Maggiore, Milan, Italy
CardioacintTM (Oakefield, U.K.) is a previously described non-imagin~ nuclear techniquethat continouslymonitorizeleft ventricularsysto-diastolic function using a miniaturizedgamma-cameraover left ventricleregion, Aim of the study was to assess the usefulnessof Cardioscint to seriatelymeasure left ventricular function in patients (pts) with acute coronary sindrome (ACS). To this end we comparedCardioacint with ecocardiographyin term~ of analyzing systolic and diastolic functionparameters.We evaluated 12 pts (8 males and 4 females, mean age 58.7• years) with ACS in absence el valvular or congenital disease in normal sin us rythm and withou t arrbythmias Each patient was undertaken to angiocardiographic monitoring followec
within 1hourby twodimensionalandDopplerechocardiographicexamination Cardioacint was performed previous injection of stannose pyrophosphate and 20 mCi of 99m-Tc. End-diastolic volume (EDVc), end-systolicvolume (ESVc), ejection fraction (EPc), peak filling rate (PFRc) and one-thir~ diastolic filling(F3c)werestudied.Tothe two dimensionalechocardiograpb) we examined the left ventricular systolic function with ejection fractior (EFe) determining ventricular volumes from apical four chamber with the single plane area lenght method. From inflow pattern recorded in the apica~ for chamber view (with sample volume positioned within the left ventricle near the free edges of the mitral leaflets) we evaluated by pulsed Dopplel echocardiography, diastolic filling using early flow peak velocity (E), late peak velocity (A), E/A ratio, acceleration time (AT) deceleration time (DT) total flowvelocityintegral (FVI)and at one-thirdof diastole(E3e) and E/FV] ratio (PFRe).RESULTS: the EFc was 0.47i'O.12 and the EFe was 0.48i'0.~ (r=0.96). By diastolic filling study we observed F3c of 30.1+13.4% and F3r 41:t:9.5% (r=O.93).PFRc was 4.53i-0.78 stroke vol/sec and PFRe 4.87+1.4~ strokevol/sec(r=O.72).CONCLUSIONS: weobtained a verygoodcorrelatiot between Cardioacint and two-dimensionalechocardiographic data in tl~ study of left van~cular systolic function; good correlation was found it diastolic fillingmeasurementsamong two methods.
Fourteen patients with stenosed (>70%) LAD or RC artery (normal Cx) and previous infarction (1-6 months) in vessel related myocardium were studied by TI-201 at rest (TI-RS) and redistribution (T1-RD), Tc-99m Tetrofosmin at rest (TF-RS), baseline echo (E-BA) and low dose (5-10 pg/Kg/min) Dobuta'mine echo (E-DO). SPET assessment of perfusion was obtained both quantitatively and qualitatively and waU motion before and during E-DO was evaluated in 16 segments for each patient. Abnormalcy rate of perfusion was 30, 25 and 25% of 224 segments for TI-RS, TI-RD and TF-RS respectively. Perfusion score improved between TI-RS and TI-RD in 23/69 abnormal segments (33%), as expected, and in 24/69 segments (35%) between TI-RS and TF-RS. TF uptake in segments with Thallium redistribution (RED) ranged from 100 to 36% (mean 59%); in segments without RED 80 to 19% (mean 46%). Wall motion improved during E-DO in 10% of the h.vpocontractile segments. TF uptake in these segments was 87f17~ in segments with no E-DO response TF uptake was 74*21%. Our data support the aptitude of TF-rest SPET imaging in the evaluation of residual viability in infarcted patients with LAD or RC single vessel disease. Best agreement between TI-201 redistribution and wall motion improvement after low dose E-DO was obtained in hypoperfused segments with 54 to 62% of normal Tetrofosmin uptake in Cx artery supply territory.
$43
T U E S D A u P M
P07-170
Tuesday AM, April 25
INCREMENTAL DIAGNOSTIC VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY (DSE)AND Tc-99m MIBI-SPECT FOR DETECTION OF CORONARY ARTERY DISEASE (CAD).
$25-172 to $32-204 and P08-205 to P13-263
V.Di Bello, CR.Bellina, E.Gori*, L.Talarico, G. Boni, N.Molea, C.Di Muro, E.Magagnini, F. Matteuoci, M.T. Caputo, E.Lazzeri, D. Giorgi, G. Santoro, R. Bianchi, C.Giusti. II Clinical Medical Institute, Nuclear Medicine, University of Pisa; * Statistic Department, University of Florence, ITALY. The incremental diagnostic value of DSE and MIBI-SPECT, for the evaluation of presence and extent of CAD, was assessed with ordered logistic regression and receiver-operating characteristic curves in forty five consecutive patients (33 males and 12 females: 53 • 6.8 y.), referred for a moderate level of pre-test probability for CAD; none of patients bad prior myocardial infarction. DSE was performed following standard protocol; one minute before the stop of test, an injection of 740 MBq of MIBI was i.v. infused. The stress MIBI SPECT imaging were acquired one hour after stress. For resting study patients were injected of 740 MBq of MIBI between 24-36 b after stress. Coronary angiography was performed in all patients (significant coronary stenosis >50%). Clinical data (sex, age, presence of chest pain, positivity of ECG during tes0 were 64.3%• 10.7 accurate in prediction of CAD. The addition to clinical model of DSE data (wall motion stress and rest score index and relative difference) yielded a diagnostic accuracy of 81.4%+4.3 (p<0.159); whereas the addition to clinical model of SPET parameters (perfusional stress and rest score index and relative difference) improved diagnostic accuracy to 92.3% -+ 5.5 (p<0.003). Both nonmvasive methods for detection of CAD (DSE and SPECT) showed a good diagnostic accuracy especially when tests-derived parameters were combined with clinical dam. SPECT model showed an higher sensitivity essentially in presence of a lower exent of CAD.
$25-172 SAFETY O F 1SOPROTERENOL STRESS TEST ASSOCIATED WITH NUCLEAR TECHNIQUES, Ph. P6zard, Ph. Bienvenu, A. Furber, Ph.Geslin. J. J Lejeune, A. Tadei, P. Jaltet, C H U Angers, France. Isoproterenol (IPNA) stress test may be an useful alternative to Dobutamine test but its safety' remains controversial. We report the side-effects observed on 800 consecutive patients (pts) undergoing IPNA stress myocardial scintigraphy (n = 449) or radionuclide angiography (n = 351). 344 pts had a proven CAD, 68 pts had three-vessel disease or left main artery stenosis. Ejection fraction (EF) was < 0.30 in 54 pts. - Methods : After Atropin IV 1 rag, IPNA was infused in incremental doses since heart rate was _>130 bpm. - Results : Death, acute cardiac failure, life-threatening arrhytmias did not occur. There is no relationship between arrhytmia and C A D or low EF presence. side-effects N % ST-segment depression _> 1,5 m m 150 19 non-Q-wave in farction 1 0.1 paradoxal bradycardia 17 2 nonsustained VT 5 0.6 PVCs (> 5 mn) 124 15 Supraventricular arrhytmias 27 3.4 Thus, IPNA stress after atropin is safe. It is performed faster than currently described Dobutamine stress test.
A P R I L
Abstracts Tuesday morning, April 25, 1995
P07-169
P07-171
NON-IMAGING ANGIOCARDIOGRAPHIC MONITORING (CARDIOSCINTTM) AND ECOCARDIOGRAPHYFOR EVALUATING LEFT VENTRICULAR FUNCTIONIN PATIENTSWITH CORONARY ARTERY DISEASE. PRELIMINARYDATA.
Tc-99m SPET TETROFOSMIN VS TI-201 SPET REST/ REDISTRIBUTION AND DOBUTAMINE ECHO IN VIABILITY ASSESSMENT AFTER AMI IN SINGLE VESSEL CAD
Carla Silenzi,Nino Ciampani, Marco Mazzanti, Carlo Costantini, Giovann: Cianci, AugustoPurcaro. Lancisi Heart Hospital, Italy.
R.Benti, U.La Marchesina, A.Finzi, G.Marotta, A.Bnmo, C.Canzi, M.Caslellani, E.Reschini, S.Perlini, C.Sdraiati, P.Gemndini. Nuclear Medicine Dept.- Ospedale Maggiore, Milan, Italy
CardioacintTM (Oakefield, U.K.) is a previously described non-imagin~ nuclear techniquethat continouslymonitorizeleft ventricularsysto-diastolic function using a miniaturizedgamma-cameraover left ventricleregion, Aim of the study was to assess the usefulnessof Cardioscint to seriatelymeasure left ventricular function in patients (pts) with acute coronary sindrome (ACS). To this end we comparedCardioacint with ecocardiographyin term~ of analyzing systolic and diastolic functionparameters.We evaluated 12 pts (8 males and 4 females, mean age 58.7• years) with ACS in absence el valvular or congenital disease in normal sin us rythm and withou t arrbythmias Each patient was undertaken to angiocardiographic monitoring followec
within 1hourby twodimensionalandDopplerechocardiographicexamination Cardioacint was performed previous injection of stannose pyrophosphate and 20 mCi of 99m-Tc. End-diastolic volume (EDVc), end-systolicvolume (ESVc), ejection fraction (EPc), peak filling rate (PFRc) and one-thir~ diastolic filling(F3c)werestudied.Tothe two dimensionalechocardiograpb) we examined the left ventricular systolic function with ejection fractior (EFe) determining ventricular volumes from apical four chamber with the single plane area lenght method. From inflow pattern recorded in the apica~ for chamber view (with sample volume positioned within the left ventricle near the free edges of the mitral leaflets) we evaluated by pulsed Dopplel echocardiography, diastolic filling using early flow peak velocity (E), late peak velocity (A), E/A ratio, acceleration time (AT) deceleration time (DT) total flowvelocityintegral (FVI)and at one-thirdof diastole(E3e) and E/FV] ratio (PFRe).RESULTS: the EFc was 0.47i'O.12 and the EFe was 0.48i'0.~ (r=0.96). By diastolic filling study we observed F3c of 30.1+13.4% and F3r 41:t:9.5% (r=O.93).PFRc was 4.53i-0.78 stroke vol/sec and PFRe 4.87+1.4~ strokevol/sec(r=O.72).CONCLUSIONS: weobtained a verygoodcorrelatiot between Cardioacint and two-dimensionalechocardiographic data in tl~ study of left van~cular systolic function; good correlation was found it diastolic fillingmeasurementsamong two methods.
Fourteen patients with stenosed (>70%) LAD or RC artery (normal Cx) and previous infarction (1-6 months) in vessel related myocardium were studied by TI-201 at rest (TI-RS) and redistribution (T1-RD), Tc-99m Tetrofosmin at rest (TF-RS), baseline echo (E-BA) and low dose (5-10 pg/Kg/min) Dobuta'mine echo (E-DO). SPET assessment of perfusion was obtained both quantitatively and qualitatively and waU motion before and during E-DO was evaluated in 16 segments for each patient. Abnormalcy rate of perfusion was 30, 25 and 25% of 224 segments for TI-RS, TI-RD and TF-RS respectively. Perfusion score improved between TI-RS and TI-RD in 23/69 abnormal segments (33%), as expected, and in 24/69 segments (35%) between TI-RS and TF-RS. TF uptake in segments with Thallium redistribution (RED) ranged from 100 to 36% (mean 59%); in segments without RED 80 to 19% (mean 46%). Wall motion improved during E-DO in 10% of the h.vpocontractile segments. TF uptake in these segments was 87f17~ in segments with no E-DO response TF uptake was 74*21%. Our data support the aptitude of TF-rest SPET imaging in the evaluation of residual viability in infarcted patients with LAD or RC single vessel disease. Best agreement between TI-201 redistribution and wall motion improvement after low dose E-DO was obtained in hypoperfused segments with 54 to 62% of normal Tetrofosmin uptake in Cx artery supply territory.
$43
T U E S D A u P M
P07-170
Tuesday AM, April 25
INCREMENTAL DIAGNOSTIC VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY (DSE)AND Tc-99m MIBI-SPECT FOR DETECTION OF CORONARY ARTERY DISEASE (CAD).
$25-172 to $32-204 and P08-205 to P13-263
V.Di Bello, CR.Bellina, E.Gori*, L.Talarico, G. Boni, N.Molea, C.Di Muro, E.Magagnini, F. Matteuoci, M.T. Caputo, E.Lazzeri, D. Giorgi, G. Santoro, R. Bianchi, C.Giusti. II Clinical Medical Institute, Nuclear Medicine, University of Pisa; * Statistic Department, University of Florence, ITALY. The incremental diagnostic value of DSE and MIBI-SPECT, for the evaluation of presence and extent of CAD, was assessed with ordered logistic regression and receiver-operating characteristic curves in forty five consecutive patients (33 males and 12 females: 53 • 6.8 y.), referred for a moderate level of pre-test probability for CAD; none of patients bad prior myocardial infarction. DSE was performed following standard protocol; one minute before the stop of test, an injection of 740 MBq of MIBI was i.v. infused. The stress MIBI SPECT imaging were acquired one hour after stress. For resting study patients were injected of 740 MBq of MIBI between 24-36 b after stress. Coronary angiography was performed in all patients (significant coronary stenosis >50%). Clinical data (sex, age, presence of chest pain, positivity of ECG during tes0 were 64.3%• 10.7 accurate in prediction of CAD. The addition to clinical model of DSE data (wall motion stress and rest score index and relative difference) yielded a diagnostic accuracy of 81.4%+4.3 (p<0.159); whereas the addition to clinical model of SPET parameters (perfusional stress and rest score index and relative difference) improved diagnostic accuracy to 92.3% -+ 5.5 (p<0.003). Both nonmvasive methods for detection of CAD (DSE and SPECT) showed a good diagnostic accuracy especially when tests-derived parameters were combined with clinical dam. SPECT model showed an higher sensitivity essentially in presence of a lower exent of CAD.
$25-172 SAFETY O F 1SOPROTERENOL STRESS TEST ASSOCIATED WITH NUCLEAR TECHNIQUES, Ph. P6zard, Ph. Bienvenu, A. Furber, Ph.Geslin. J. J Lejeune, A. Tadei, P. Jaltet, C H U Angers, France. Isoproterenol (IPNA) stress test may be an useful alternative to Dobutamine test but its safety' remains controversial. We report the side-effects observed on 800 consecutive patients (pts) undergoing IPNA stress myocardial scintigraphy (n = 449) or radionuclide angiography (n = 351). 344 pts had a proven CAD, 68 pts had three-vessel disease or left main artery stenosis. Ejection fraction (EF) was < 0.30 in 54 pts. - Methods : After Atropin IV 1 rag, IPNA was infused in incremental doses since heart rate was _>130 bpm. - Results : Death, acute cardiac failure, life-threatening arrhytmias did not occur. There is no relationship between arrhytmia and C A D or low EF presence. side-effects N % ST-segment depression _> 1,5 m m 150 19 non-Q-wave in farction 1 0.1 paradoxal bradycardia 17 2 nonsustained VT 5 0.6 PVCs (> 5 mn) 124 15 Supraventricular arrhytmias 27 3.4 Thus, IPNA stress after atropin is safe. It is performed faster than currently described Dobutamine stress test.
A P R I L