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Myocardial segmentary viability patterns in patients with ischemic cardiomyopathy
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Abstracts M o n d a y a f t e r n o o n , A p r i l 24, 1995
JOURNAL OF NUCLEAR CARDIOLOGY M a r c h / A p r i l 1995, Part 2
P07-159
P07-157 M O N D A Y P M A P R I L
Myocardial ~,gmentuff Cardiomyopoth?
Viability
Patterns
in
Patients
with
Is(heroic
MYOCARDIAL ISCHAEMIA DETECTION: 99mTc-SESTAM1BI ECHOCARDIOGRAPNHYDURINGDOBUTAMINESTRESS.
VERSUS
O, Masoli, N. Perez Balifio, A~ Merette, A. Di Leva, F Otero, D, (ragnolino. Hospi.~.l Argerich Universidad de BuenosAires - BuenosAires, Argentina
G. Cantlnho, A. Perelrloba, A.I. Santos, M. Flliza, L. Olivelra, E. Dlas, M.G. Lopes, F. Godlnho. Institute de Medlclna Nuclear and UCIM/Med IV, LA3 CCUL Hospital de Santa Maria, Llsbea -Portugal
Objeaires: IdentiGc~un of normal, [schemic, stunned, hibernated, ,~, necratic 'segmenter/ ~rns', i~ ~ent~ ~ith ~siti~ or rmga~ve LVEF responseto Amm,~n~ (~,md. Metbadr: 20 ~tients (~) with CAO and previous myocardial infarctions and LVEF < 40 %, were oras~ly enrolled. Planar Thallium 201 e~cersisestresspeffosion images (S TI),4 h(s redistdb~on, and reinje~on (Ri) protocol was done. RN.~ Lu were obtained at rest, and 20 min~s d~r ] rag/k9 i.v. at/~mrhahn. Ih furiously6e~nibed~,mrresl~r~ was tonsider~ positive when LVEF increased at least 30 % above the re~'t value. Six segments (sg) (Septel, Apical, Inferior, Posterior, Lateral, and Anterior) were consideredin wall motion (WM) analysis using LAG and anterior views. WM was classified~.~ normal (NI) or abnormal (AbN)~ S_T/sg as Hi or hbN, whereas 9 images us improved (I) or having no changes (Hth). ~ were dividedin two groups: GroupA (6,4): Positiveresponseto Amr 7 pts (42 seg), and GroupB (GB): Negate response13 pts (78 seg). "Segmentary pattern' was classifiedas 'Normal' (Nl restWM I HI s TI / Nchn Ri), 'lschemk' (NI restWM/AbN S TII I Ri), 'Stunned" (AhN rest WM / NI S_TI / Nth Ri), "Hibernated' (AbN restWM / Abt,I S Ii/ I Ri) or 'Necrotic' (AbN restWM / AbN 511 / NL'hRi). Irem~ts: GA (n=42 ~Q) GB (n~78 ~) Chi Square Normal 19 % (8/421 8 % (6/'/8) pns 2 % (2/78) pns Isthemic O% Stunned 26 %'(i'i142) 15 % (12/78) pns p = .06 Hibernated 50 % (21/42) 31% (24/78) IpnS Netrofit i 'S % (2/42) 44 % (34/78) p < .001
We have used stress dobutamine to compare echocardiography (Echo) with 99mTc-Sestamibi (MIBI). 87 patients (pts) were studied, 74 males and 13 females,-57.4++10 years, 56 pts with previous myocardial infarction and 31 with angor; 36 pts had coronariography. Pts were infused with dobutamine until maximal dose of 40mg/kg/min or a new regional wall motion abnormality (RWMA) was detected by Echo or if standard clinical criteria appeared. No major side effects were referred. During the infusion Echo study was performed and 15 mCi of MIBI was administered at test end. Rest SPECT was performed at 48 hours. MIBI and Echo were analyzed qualitatively, considering 12 segments of left ventricle. We considered two lesions types: necrosis= irreversible M1BI lesions=stress and rest Echo RWMA and isehaemi~reversibleMIBI lesions=stress Echo RWMA. Of 1044 segments analyzed, 78% had the same classification. The anterior wall was the most discordant (73%).The most concordant studies were in the patients without previous infarction (86%). For myocardial isehaemia, we found only 24% concordance. Coronariography results: 36 pts with significants lesions in 49 vessels (lesion >- 70%) The global coronariography/MIBI concordance was 82% and 62%for Echo. Our results show a poor match in the detection of ischaemie myocurdiam, the main purpose of the method. No statistical differences related with the infarction localization were found. In pts without previous myocardial infarction we have obtained better results, perhaps because the valorization of RWMA is easier, which may account for the principal indication for s~ess Echo.
CONCLUSIONS: Analysis of regional wall motion at rest, and slress - reiniscfion TI 201 porfusionimages, could be usefulto identify segmentswith different fundional status. Necrotic myocardial segmentarypattern was predominantly associatedwith negative responseto amrinane.
P07-158
P07-160
DIRECT COMPARISON OF LOW-DOSE DOBUTAMINE E C H O C A R D I O G R A P H Y AND T H A L L I U M SPECT FOR DELINEATION OF M Y O C A R D I A L VIABILITY
DETECTION OF VIABLE MYOCARDIUM BY CONTRAST ECHOCARDIOGRAPHY AND REST 99mTc-MIBI SPET. A PRELIMINARY STUDY
J-L. Vanoverschelde, B.L. Gerber, T. Marwick, A-M. D'Hondt, W. Wijns, J.A. Melin, University of Louvain, Brussels, Belgium
G . R u b i n i , S . l l i c e t o , F . L a u r i e r o , D . R u b i n i , L. G a l i u t o , L. Sorgente, M. L e p e r a P . R i z z o n , A. D ' A d d a b b o . Depts. of Nuclear Medicine, University o f Bari- Italy
The accuracy of low-dose dobutamine echocardiography (DbE) and exercise- redistribution- reinjection thallium (TI) SPECT for prediction of myocardial viability was studied in 52 patients (pts) with coronary disease and regional LV dysfunction undergoing revascularization (RVS). Recovery of function was evaluated by echo 5 + 3 months after RVS. Wall motion was graded in 16 segments from normal (1) to akinetic (3). At tbllow-up, 32/52 pts were considered to have viable myocardium based on improved wall motion in -> 2 adjacent akinetie segments and no deterioration of global LV function, while 20/52 pts had no viable tissue and further increased LV volumes. An improved wall motion in ~ 2 adjacent akinetic segments during DbE (10 /~g/kg/min) correctly identified 88% of the pts with and 75% of those without viable myocardium. Overall accuracy was 83%. With TI, visual redistribution had a sensitivity of 78 %, a specificity of 35 % and an accuracy of 62 %; quantitative redistribution (increase in TI uptake >10% from exercise to redistribution or reinjection) had a sensitivity of 50%, a specificity of 45% and an accuracy of 48%; and a > 5 0 % TI uptake at reinjection on adjacent short-axis crosssections had a sensitivity of 75%, a specificity of 70% and an overall accuracy of 73% (NS vs DbE). Thus, both DbE and quantitative TI SPECT have comparable accuracy for identification of reversible dysfunction in patients with chronic LV dysfunction due to coronary artery disease.
Two dimensional echocardiography (2DE) evaluates myocardial d y s f u n c t i o n s and, d u r i n g i n f u s i o n o f L o w D o s e D o b u t a m i n e (LDD) r e c o g n i s e s h y p o - a k i n e t i c M y o c a r d i a l S e g m e n t s (MS) with contractile reserve. Myocardial Contrast Eechocardiography ( M C E ) w i t h intracoronary i n j e c t i o n of a s o n i c a t e d contrast medium gives information about myocardial microvascular integrity. From intraceUular uptake of 99mTc-MIBI it is possible to obtain the regional perfusion pattems. To evaluate i f there is a 99mTc M I B I uptake in post-infarction dysfunctioning M S with contractile reserve and m i c r o v a s c u l a r integrity, we studied 6 pts w i t h A M I (4 anterior, 1 l a t e r a l and 1 posterior). All pts underwent 2 D E monitoring, L D D (up to 10 m c g / k g / m i n ) at day 5, M C E at the time of coronary angiography, and rest 99mTcM I B I S P E T w a s performed w i t h i n 2 days. A 16 s e g m e n t model was used to analyse the data. 34 o f 96 M S w e r e h y p o or akinetics at first 2DE. 19 MS s h o w e d L D D improved kinetic (+), M C E microvascular integrity (+) and 99mTc-MIBI uptake (+); 8 MS L D D no i m p r o v e d k i n e t i c (-), M C E no m i c r o v a s c u l a r integrity (-) and no 9 9 m T c - M I B I (-); 4 M S were L D D -, but M C E + and 9 9 m T c - M I B I +. 2 M S L D D +, M C E + and 99mTcM I B I -; 1 MS L D D -, M C E - and 9 9 m T c - M I B I +. There is good agreement (91,2%) between M C E and rest 9 9 m T c - M I B I uptake, and a m o n g the three techineques (79,4%). 9 9 m T c - M I B I uptake in h y p o - a k i n e t i c M S is a m a r k e r of postinfarction m y o c a r d i a l viability.
Abstracts M o n d a y a f t e r n o o n , A p r i l 24, 1995
JOURNAL OF NUCLEAR CARDIOLOGY M a r c h / A p r i l 1995, Part 2
P07-159
P07-157 M O N D A Y P M A P R I L
Myocardial ~,gmentuff Cardiomyopoth?
Viability
Patterns
in
Patients
with
Is(heroic
MYOCARDIAL ISCHAEMIA DETECTION: 99mTc-SESTAM1BI ECHOCARDIOGRAPNHYDURINGDOBUTAMINESTRESS.
VERSUS
O, Masoli, N. Perez Balifio, A~ Merette, A. Di Leva, F Otero, D, (ragnolino. Hospi.~.l Argerich Universidad de BuenosAires - BuenosAires, Argentina
G. Cantlnho, A. Perelrloba, A.I. Santos, M. Flliza, L. Olivelra, E. Dlas, M.G. Lopes, F. Godlnho. Institute de Medlclna Nuclear and UCIM/Med IV, LA3 CCUL Hospital de Santa Maria, Llsbea -Portugal
Objeaires: IdentiGc~un of normal, [schemic, stunned, hibernated, ,~, necratic 'segmenter/ ~rns', i~ ~ent~ ~ith ~siti~ or rmga~ve LVEF responseto Amm,~n~ (~,md. Metbadr: 20 ~tients (~) with CAO and previous myocardial infarctions and LVEF < 40 %, were oras~ly enrolled. Planar Thallium 201 e~cersisestresspeffosion images (S TI),4 h(s redistdb~on, and reinje~on (Ri) protocol was done. RN.~ Lu were obtained at rest, and 20 min~s d~r ] rag/k9 i.v. at/~mrhahn. Ih furiously6e~nibed~,mrresl~r~ was tonsider~ positive when LVEF increased at least 30 % above the re~'t value. Six segments (sg) (Septel, Apical, Inferior, Posterior, Lateral, and Anterior) were consideredin wall motion (WM) analysis using LAG and anterior views. WM was classified~.~ normal (NI) or abnormal (AbN)~ S_T/sg as Hi or hbN, whereas 9 images us improved (I) or having no changes (Hth). ~ were dividedin two groups: GroupA (6,4): Positiveresponseto Amr 7 pts (42 seg), and GroupB (GB): Negate response13 pts (78 seg). "Segmentary pattern' was classifiedas 'Normal' (Nl restWM I HI s TI / Nchn Ri), 'lschemk' (NI restWM/AbN S TII I Ri), 'Stunned" (AhN rest WM / NI S_TI / Nth Ri), "Hibernated' (AbN restWM / Abt,I S Ii/ I Ri) or 'Necrotic' (AbN restWM / AbN 511 / NL'hRi). Irem~ts: GA (n=42 ~Q) GB (n~78 ~) Chi Square Normal 19 % (8/421 8 % (6/'/8) pns 2 % (2/78) pns Isthemic O% Stunned 26 %'(i'i142) 15 % (12/78) pns p = .06 Hibernated 50 % (21/42) 31% (24/78) IpnS Netrofit i 'S % (2/42) 44 % (34/78) p < .001
We have used stress dobutamine to compare echocardiography (Echo) with 99mTc-Sestamibi (MIBI). 87 patients (pts) were studied, 74 males and 13 females,
CONCLUSIONS: Analysis of regional wall motion at rest, and slress - reiniscfion TI 201 porfusionimages, could be usefulto identify segmentswith different fundional status. Necrotic myocardial segmentarypattern was predominantly associatedwith negative responseto amrinane.
P07-158
P07-160
DIRECT COMPARISON OF LOW-DOSE DOBUTAMINE E C H O C A R D I O G R A P H Y AND T H A L L I U M SPECT FOR DELINEATION OF M Y O C A R D I A L VIABILITY
DETECTION OF VIABLE MYOCARDIUM BY CONTRAST ECHOCARDIOGRAPHY AND REST 99mTc-MIBI SPET. A PRELIMINARY STUDY
J-L. Vanoverschelde, B.L. Gerber, T. Marwick, A-M. D'Hondt, W. Wijns, J.A. Melin, University of Louvain, Brussels, Belgium
G . R u b i n i , S . l l i c e t o , F . L a u r i e r o , D . R u b i n i , L. G a l i u t o , L. Sorgente, M. L e p e r a P . R i z z o n , A. D ' A d d a b b o . Depts. of Nuclear Medicine, University o f Bari- Italy
The accuracy of low-dose dobutamine echocardiography (DbE) and exercise- redistribution- reinjection thallium (TI) SPECT for prediction of myocardial viability was studied in 52 patients (pts) with coronary disease and regional LV dysfunction undergoing revascularization (RVS). Recovery of function was evaluated by echo 5 + 3 months after RVS. Wall motion was graded in 16 segments from normal (1) to akinetic (3). At tbllow-up, 32/52 pts were considered to have viable myocardium based on improved wall motion in -> 2 adjacent akinetie segments and no deterioration of global LV function, while 20/52 pts had no viable tissue and further increased LV volumes. An improved wall motion in ~ 2 adjacent akinetic segments during DbE (10 /~g/kg/min) correctly identified 88% of the pts with and 75% of those without viable myocardium. Overall accuracy was 83%. With TI, visual redistribution had a sensitivity of 78 %, a specificity of 35 % and an accuracy of 62 %; quantitative redistribution (increase in TI uptake >10% from exercise to redistribution or reinjection) had a sensitivity of 50%, a specificity of 45% and an accuracy of 48%; and a > 5 0 % TI uptake at reinjection on adjacent short-axis crosssections had a sensitivity of 75%, a specificity of 70% and an overall accuracy of 73% (NS vs DbE). Thus, both DbE and quantitative TI SPECT have comparable accuracy for identification of reversible dysfunction in patients with chronic LV dysfunction due to coronary artery disease.
Two dimensional echocardiography (2DE) evaluates myocardial d y s f u n c t i o n s and, d u r i n g i n f u s i o n o f L o w D o s e D o b u t a m i n e (LDD) r e c o g n i s e s h y p o - a k i n e t i c M y o c a r d i a l S e g m e n t s (MS) with contractile reserve. Myocardial Contrast Eechocardiography ( M C E ) w i t h intracoronary i n j e c t i o n of a s o n i c a t e d contrast medium gives information about myocardial microvascular integrity. From intraceUular uptake of 99mTc-MIBI it is possible to obtain the regional perfusion pattems. To evaluate i f there is a 99mTc M I B I uptake in post-infarction dysfunctioning M S with contractile reserve and m i c r o v a s c u l a r integrity, we studied 6 pts w i t h A M I (4 anterior, 1 l a t e r a l and 1 posterior). All pts underwent 2 D E monitoring, L D D (up to 10 m c g / k g / m i n ) at day 5, M C E at the time of coronary angiography, and rest 99mTcM I B I S P E T w a s performed w i t h i n 2 days. A 16 s e g m e n t model was used to analyse the data. 34 o f 96 M S w e r e h y p o or akinetics at first 2DE. 19 MS s h o w e d L D D improved kinetic (+), M C E microvascular integrity (+) and 99mTc-MIBI uptake (+); 8 MS L D D no i m p r o v e d k i n e t i c (-), M C E no m i c r o v a s c u l a r integrity (-) and no 9 9 m T c - M I B I (-); 4 M S were L D D -, but M C E + and 9 9 m T c - M I B I +. 2 M S L D D +, M C E + and 99mTcM I B I -; 1 MS L D D -, M C E - and 9 9 m T c - M I B I +. There is good agreement (91,2%) between M C E and rest 9 9 m T c - M I B I uptake, and a m o n g the three techineques (79,4%). 9 9 m T c - M I B I uptake in h y p o - a k i n e t i c M S is a m a r k e r of postinfarction m y o c a r d i a l viability.