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Myocardial perfusion in patients with DDD pacing
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
Abstracts Monday morning, April 7, 1997
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MYOCARDIAL PERFUSION IN PATIENTS W I T H DDD PACING A. Le Helloco, A. Devillers, J. L. Alberini, M. Bedossa, P. Bourguet, C. Almange. Department of Cardiology and Nuclear Medecine, University Hospital, Rennes, France
IS D I P Y R I D A M O L E - t N D U C E D S T - S E G M E N T DEPRESSION SPECIFIC E N O U G H [N DETECTING C O R O N A R Y A R T E R Y DISEASE ? DJ Wang, CY Cheng, SP Yang, WL Chen, DA Wu. TriService General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Exercise myocardial tomography could localize ischemia in patients (pts) with DDD pacing, but myocardial perfusion abnormalities are possible, 48 10ts implanted with DDD pacemaker for high degree AV block (38 pts) and sick sinus syndrome ( | 0 pts) were divided in group 1 (24 pts) without significative coronary stenosis, in group 2 (24 pts) with 14 one vessel disease (v.d.), 5 two v.d. and 5 three v.d.. Angina was present in 36 pts, atypic/q chest pain in 12 pts and myocardial infarction in 13 pts. All pts underwent exercise test (E.T.)coupled with dipyridamole Thallium tomography (SPECT) and coronary angiogram. Exercise test is insufficient for diagnosis of coronary artery disease (C.A.D.) : 10 pts with angina in group 2 vs 2 pts in group 1 (p < 0,01).Sensitivity (SE) of SPECT is excellent (95,8 %), but apical defect is frequent in group 1 (specificity SP = 54,2 %). SE SP LA.D. 66,6 % 59,4 % LC.X. 62,5 % 93,7 % R.C.A. 81,8 % 69,2 % In pts with DDD pacemaker, dipyridamole SPECT is useful for diagnosis of C.A.D..
Dipyridamole-induced ST-segment depression (STD) is not unusual in intravenous dipyridamole thallium-201 myocardial perfusion imaging (IVDTL). To testify the diagnostic accuracy IDA) of the STD in detecting coronary artery disease (CAD), 126 subjects underwent IVDTL were included in this study. Of the 126 cases, 28 had angiographically proved normal coronary arteries and 98 had CAD with exclusion of myocardial infarct. In comparison with the DA o f reversible perfusion defects (PD), the DA of STD, chest 3ain and noncardiac SIS (symptoms and signs) in detectIn~l CAD were: SN, sensitivity; SP: specificit N (n=28) CAD (n=98) SN ; SP DA positive negative positive I negative! (%) i (%) (%) !STD:=:' ::'l :1 2 2 : 7 6 : 3 9 .'hest pain 6 22 2,5 73 26 78 37 ~loncardiacSIS 12 16 30 68 31 57 36 ,Reversible PD 1 5 I 23 I 87 I t l 1891821 87 It is therefore concluded that 1) the cardiac (STD and chest pain) and noncardiac SIS are not accurate indicators in CAD detection, and 2) the ST-depression during dipyridamole infusion is a very specific, but not sensitive, indicator in detecting CAD.
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INFLUENCE OF PREVIOUS MYOCARDIAL INFARCTION ON THE DIAGNOSTIC VALUE OF Tc99m-TETROFOSMtN SPECT Freire JM, Fajares M, Nieto R*, Becerra D*, Otero E, Lumbreras L*, Sancho M, MSempere J*,University Hospital Cadiz*Granada Spain.
USEFULNESS OF REST IODINE-123- 13-METYL [ODOPHENYL-PENTADECANOICACID (BMIPP) IMAGES TO DIAGNOSE UNSTABLE ANGINA PECTORIS - ESTIMATION USING DELAYED IMAGE-. T.Hatori, T.Toyama, H.Hosizaki, T.Iizuka, N.Kanazawa, H.Wakamatu, H.Arisawa, T.Inoue, K,Endou, T.Suzuki, O. Uchida, R.Nagai. The Society of Gunma Myocardial Metabolism,Macbasi,Japan.
The aim of this study was to analyze if the previous myocardial infarction (Mt) modifie the sensitivity (SN) and specificity (SP) of 99mTc-tetrofoemin myocardia~imaging in the detection of significant coronary stenosis. SPECT 99mTc Tetrofosmin one-day stress-rest imaging protocol were performed in 115 patients (89M, 26F) who had undergone diagnostic coronary angiography. Sixty-three patients (pt) showing pdor myocardial infarction, There were 20 pt with no coronary axteryd~sease(CAD), 43 pt ~4th one-vessel (~7G% diameter narrowing as significant stenosis), 29 pt with two-vessels and 23 pt with three-vessels disease. Myocardial SPECT data were evaluated visually by two independent observer using a five segment five score system (0: normal to 4: absent uptake). The Sensitivity for CAD detection were 100% in patients with and whitout prior MI. We observed diferences (p=0.03) in the detection of significant stenosis between patients with MJ (8N:90%) and patients without MI (SN.80%). Concerning localization of individual coronary artery (n=345), the following values were obtaining: SENSITIVITY ALL WITH MI WHITOUT M[ LAD 90% 93% (38141) 86% (25129) n.s. LCX 73% 82% (23/28) 54% (7/13) n.s. RCA 90% 93% (38141) 62% (14117) n.s. SPECIFICITY LAD 80% 77% (17/22) 83% (19123) n.s. LCX 95% 97% (34135) 92% (36139) n.s RCA 89% 86% (19/22) 91% (32t35) n.s. Our result suggest that the diagnostic value of Tc99m-Tetrofosmin SPECT is similar both Jn patients with and without MI.
We estimated delayed BMIPP scintigraphy to diagnose unstable angina pectoris (UAP). Sixteen patients with UAP underwent the rest early and delayed BMIPP imaging and TI imaging on the other day. In 21 segments of the SPECT, regional tracer uptake was scored using 4-grade uptake score, and summed up to defect score (RDS). Coronary arteriography was done in "allpatients and the stenosis above 75% was thought to be significant. The diagnostic rate was 48%(10/21) on the rest TI imaging, 76% (16/21) on the early image and 90% (19/21) on the delayed image of BMIPP imaging, whose RDS was 2.0 ----2.7, 5.1 +4.7* and 6.3--5.7% respectively ( * ; p<0.01 vs T1 ).We conclude that the rest delayed BMIPP image is useful to diagnose unstable angina pectofis.
$9
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Abstracts Monday morning, April 7, 1997
8.18
8.20
MYOCARDIAL PERFUSION IN PATIENTS W I T H DDD PACING A. Le Helloco, A. Devillers, J. L. Alberini, M. Bedossa, P. Bourguet, C. Almange. Department of Cardiology and Nuclear Medecine, University Hospital, Rennes, France
IS D I P Y R I D A M O L E - t N D U C E D S T - S E G M E N T DEPRESSION SPECIFIC E N O U G H [N DETECTING C O R O N A R Y A R T E R Y DISEASE ? DJ Wang, CY Cheng, SP Yang, WL Chen, DA Wu. TriService General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Exercise myocardial tomography could localize ischemia in patients (pts) with DDD pacing, but myocardial perfusion abnormalities are possible, 48 10ts implanted with DDD pacemaker for high degree AV block (38 pts) and sick sinus syndrome ( | 0 pts) were divided in group 1 (24 pts) without significative coronary stenosis, in group 2 (24 pts) with 14 one vessel disease (v.d.), 5 two v.d. and 5 three v.d.. Angina was present in 36 pts, atypic/q chest pain in 12 pts and myocardial infarction in 13 pts. All pts underwent exercise test (E.T.)coupled with dipyridamole Thallium tomography (SPECT) and coronary angiogram. Exercise test is insufficient for diagnosis of coronary artery disease (C.A.D.) : 10 pts with angina in group 2 vs 2 pts in group 1 (p < 0,01).Sensitivity (SE) of SPECT is excellent (95,8 %), but apical defect is frequent in group 1 (specificity SP = 54,2 %). SE SP LA.D. 66,6 % 59,4 % LC.X. 62,5 % 93,7 % R.C.A. 81,8 % 69,2 % In pts with DDD pacemaker, dipyridamole SPECT is useful for diagnosis of C.A.D..
Dipyridamole-induced ST-segment depression (STD) is not unusual in intravenous dipyridamole thallium-201 myocardial perfusion imaging (IVDTL). To testify the diagnostic accuracy IDA) of the STD in detecting coronary artery disease (CAD), 126 subjects underwent IVDTL were included in this study. Of the 126 cases, 28 had angiographically proved normal coronary arteries and 98 had CAD with exclusion of myocardial infarct. In comparison with the DA o f reversible perfusion defects (PD), the DA of STD, chest 3ain and noncardiac SIS (symptoms and signs) in detectIn~l CAD were: SN, sensitivity; SP: specificit N (n=28) CAD (n=98) SN ; SP DA positive negative positive I negative! (%) i (%) (%) !STD:=:' ::'l :1 2 2 : 7 6 : 3 9 .'hest pain 6 22 2,5 73 26 78 37 ~loncardiacSIS 12 16 30 68 31 57 36 ,Reversible PD 1 5 I 23 I 87 I t l 1891821 87 It is therefore concluded that 1) the cardiac (STD and chest pain) and noncardiac SIS are not accurate indicators in CAD detection, and 2) the ST-depression during dipyridamole infusion is a very specific, but not sensitive, indicator in detecting CAD.
8.19
8.21
INFLUENCE OF PREVIOUS MYOCARDIAL INFARCTION ON THE DIAGNOSTIC VALUE OF Tc99m-TETROFOSMtN SPECT Freire JM, Fajares M, Nieto R*, Becerra D*, Otero E, Lumbreras L*, Sancho M, MSempere J*,University Hospital Cadiz*Granada Spain.
USEFULNESS OF REST IODINE-123- 13-METYL [ODOPHENYL-PENTADECANOICACID (BMIPP) IMAGES TO DIAGNOSE UNSTABLE ANGINA PECTORIS - ESTIMATION USING DELAYED IMAGE-. T.Hatori, T.Toyama, H.Hosizaki, T.Iizuka, N.Kanazawa, H.Wakamatu, H.Arisawa, T.Inoue, K,Endou, T.Suzuki, O. Uchida, R.Nagai. The Society of Gunma Myocardial Metabolism,Macbasi,Japan.
The aim of this study was to analyze if the previous myocardial infarction (Mt) modifie the sensitivity (SN) and specificity (SP) of 99mTc-tetrofoemin myocardia~imaging in the detection of significant coronary stenosis. SPECT 99mTc Tetrofosmin one-day stress-rest imaging protocol were performed in 115 patients (89M, 26F) who had undergone diagnostic coronary angiography. Sixty-three patients (pt) showing pdor myocardial infarction, There were 20 pt with no coronary axteryd~sease(CAD), 43 pt ~4th one-vessel (~7G% diameter narrowing as significant stenosis), 29 pt with two-vessels and 23 pt with three-vessels disease. Myocardial SPECT data were evaluated visually by two independent observer using a five segment five score system (0: normal to 4: absent uptake). The Sensitivity for CAD detection were 100% in patients with and whitout prior MI. We observed diferences (p=0.03) in the detection of significant stenosis between patients with MJ (8N:90%) and patients without MI (SN.80%). Concerning localization of individual coronary artery (n=345), the following values were obtaining: SENSITIVITY ALL WITH MI WHITOUT M[ LAD 90% 93% (38141) 86% (25129) n.s. LCX 73% 82% (23/28) 54% (7/13) n.s. RCA 90% 93% (38141) 62% (14117) n.s. SPECIFICITY LAD 80% 77% (17/22) 83% (19123) n.s. LCX 95% 97% (34135) 92% (36139) n.s RCA 89% 86% (19/22) 91% (32t35) n.s. Our result suggest that the diagnostic value of Tc99m-Tetrofosmin SPECT is similar both Jn patients with and without MI.
We estimated delayed BMIPP scintigraphy to diagnose unstable angina pectoris (UAP). Sixteen patients with UAP underwent the rest early and delayed BMIPP imaging and TI imaging on the other day. In 21 segments of the SPECT, regional tracer uptake was scored using 4-grade uptake score, and summed up to defect score (RDS). Coronary arteriography was done in "allpatients and the stenosis above 75% was thought to be significant. The diagnostic rate was 48%(10/21) on the rest TI imaging, 76% (16/21) on the early image and 90% (19/21) on the delayed image of BMIPP imaging, whose RDS was 2.0 ----2.7, 5.1 +4.7* and 6.3--5.7% respectively ( * ; p<0.01 vs T1 ).We conclude that the rest delayed BMIPP image is useful to diagnose unstable angina pectofis.
$9
(:: h I:
N F F I L