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Rest-redistribution Thallium-201 and rest MIBI SPECT in patients with stable CAD: A quantitativè evaluation
JOURNAL OF NUCLEARCARDIOLOGY Volume 2, Number 2, Part 2
Abstracts Wednesday afternoon, April 26, 1995
$61-441
$61-443
CLINICAL DETERMINANTS OF H E M O D Y N A M I C AND SYMPTOMATIC RESPONSES IN 1,934 PATIENTS DURING ADENOSINE SCINTIGRAPHY
Exercise ECG and Thallium 201 SPECT in patients with left main coronary artery disease. J.M. SCHOLL, F. VlGONI, V. ARJA, O CENDOYA, A. BLASCO, P. WAGNIART. Centre Cardiologique du Nord, Saint-Denis, France.
DL Johnston, DO Hodge, MR Hopfenspirger, RJ Gibbons Mayo Clinic, Rochester, Minnesota, USA.
Slll
There is individual variability in the hemodynamic and symptomatic responses during adenosine perfusion scintigraphy. To assess whether certain clinical conditions are responsible for this variability, change in hemodynamics and number of symptoms were correlated with multiple clinical variables in 1,934 patients (pts) receiving adenosine. Pts received adenosine 140 ~gm/kg/min x 6 rain or a graduated dose (50/75/100/140 ~tgmNg/min) x 7 rain. LV ejection fraction (EF) was available in 890 pts. The following clinical variables were associated with significant (p <.02-.001) responses to adenosine infusion compared to pts without the variable. ,1, = less change/ fewer symptoms; 1" = more change/more symptoms. Variable N AHR ASBP #Symptoms Aze->70yr 964 $ 1" - ,1, Diabetes 251 ,l, 1" $ Male 1058 $ 1" ,1, Atrial Fib. 127 ,1, 1" ,[, EF < 40% 167 $ 1" ,l, Possible mechanisms include autonomic dysfunction in diabetics and high circulating catecholamines in pts with low EF. Conclusion: There are several clinical variables which affect the hemodynamic and symptomatic responses to adenosine infusion.
To assess the diagnostic value of exercise Thallium 201 (TI) single photon emission computed tomography (SPECT) for the identification of patients (pts) with left main (LM) coronary artery stenosis (S), we studied 31 pts (mean age 60 _+ 10 years, 26 males, 5 females) with LM S > 50% who had exercise-redistribution SPECT. Twenty-seven pts had LM S associated with 1, 2 or 3 vessel disease respectively in 8, 9 and 10 pts; 21 of them had RCA S >_ 70% .Twenty-five out of 27 (93%) had a reversible TI defect (RD): 15 (52%) anterior, anteroseptal and/or apical, 3 (10%) anterolateral, 8 (26%) inferolateral, 11 (35%) inferior. The so called left main pattern was not observed. Four pts had isolated LM S: 3 had normal SPECT, 1 had a small anterior RD. Abnormal lung TI uptake was noted in 14 pts (45%) and ventricular cavity dilatation in 13 (42%). All the pts had a positive exercise test. Conclusion 9 despite its ability to detect CAD in 84% of these pts, SPECT could be normal and was not specific of left main disease. However when exercise testing data were added severe CAD could be identified.
$61-442
$61-444
REST-REDISTRIBUTION THALLIUM-201 AND R E S T M I B I S P E C T IN P A T I E N T S W I T H S T A B L E CAD: A Q U A N T I T A T I V E E V A L U A T I O N .
MYOVIEW FOR REST/STRESS MYOCARDIAL SPECT WITHIN 2 HOURS. A SPANISH-PORTUGUESE MULTICENTER TRIAL.
Claudio Marcassa, Alberto Cuocolo, Michele Galli, Simone Maurea, Marco Salvatore. Clinica del Lavoro Foundation IRCCS, Vemno (No) and Federico II Univ., Napoli, ITALY
RMontz,MJ.Perez-Castej6n,JA.Jurado,J.Martfn-Comfn,E.Esplugues, U Salgado,A.VentCysa,G.Cantinho,AT.Fonseca,MJ.Tabuenca,A.Garcfa, D.Ortega,C.Puente,Al Ferrer,JM Latre and JL Carreras. Complutense Univ.Madrid(Monitoring),7 centers in Spain and 4 centers in Portugal
Thallium-201 (T1) redistribution (RED) after resting injection reflects hypoperfused but viable myocardium. We compared resting MIBI with REST-4hr RED T1 uptake in 44 pts with documented CAD and regional asynergies (56-+10 yrs; LVEF 40-+15%). T1 and MIBI SPECT were performed on separate days; MIBI images were acquired 60 rain after injection. Tracer uptake was quantified in 22 seg/pt. In 456 seg with normal (>75% of peak activity) REST T1 uptake, MIBI uptake was preserved (86-+15%; >75% in 374/456, 82%). In 512 abnormal REST T1 seg, MIBI uptake was comparable to REST TI (50+18% vs 52+16%, p=ns) but was significantly lower than RED TI uptake (55-+18%, p< 0.01). Significant (>10% uptake increase) RED was documented in 147/512 (29%) abnormal REST T1 seg. Mean tracer uptake was: REST RED MIBI Seg. with RED (n=147) 51+17" 68-+17 54-+20":I: Seg. without RED (n=365) 52+15 49-+165 48+165 *p<.001 vs RED; $p<.05 vs REST In pts with chronic CAD and regional asynergies, MIBI activity 60 min after injection parallels RED TI activity in seg with fixed T1 defects only. Despite comparable resting T1 uptake, seg with RED had a greater 4hr T1 than MIBI uptake.
The diagnostic efficacy of 99mTc-tetrofosmin(Myoview)in patients with CAD was studied with a SPECT rest/stress protocol in 2 hours. Methods: The study included patients with diagnosis of uncomplicated CAD. With a radiochemical purity of >90%,each patient was injected with <__300MBq Myoview at rest and<9'O0MBq at peak of exercise. SPECT acquisitions were made l)at rest, and 2)with stress injection aprox. 1 hour after the rest injection. The images were read by 2 or 3 blinded experts in nuclear cardiology. The results were compared with those of coronary angiog:'aphy (CA). Results: From a total of 167 patients included, the data of 142 were completely evaluable (23 without CA, 2 with non evaluable images). Longer intervals between injection and SPECT acquisition at rest (32+ 14 min,n=82 vs. 7+4 min, n=85) did not influence significantly the diagnostic results. The quality of the rest images was excellent or good in 86%, Ix~orin 12% and non evaluable in 2~ The sensitivity(S) of SPECT to detect CAD with >75%/>50% steoosis was 96/93%, with an accuracy(A) of 82/85%. The localization of defects by SPECT in relation to perfusion territories of stenosed vessels (>75%~_50%) was achieved with S= 69/64% for LAD, 55/48% for LCX and 91/86% for RCA, with A-=-73/71%, 76/71'4~ and 64/73%. Concordances were 62% for single and 68% tk~r multiple vessel disease. Conclusions: This is the first large multicentcr clinical trial confirming the usefullness of Myoview in an ultrashort protocol (2 hours) myocardial rest/stress SPECT procedure.
Abstracts Wednesday afternoon, April 26, 1995
$61-441
$61-443
CLINICAL DETERMINANTS OF H E M O D Y N A M I C AND SYMPTOMATIC RESPONSES IN 1,934 PATIENTS DURING ADENOSINE SCINTIGRAPHY
Exercise ECG and Thallium 201 SPECT in patients with left main coronary artery disease. J.M. SCHOLL, F. VlGONI, V. ARJA, O CENDOYA, A. BLASCO, P. WAGNIART. Centre Cardiologique du Nord, Saint-Denis, France.
DL Johnston, DO Hodge, MR Hopfenspirger, RJ Gibbons Mayo Clinic, Rochester, Minnesota, USA.
Slll
There is individual variability in the hemodynamic and symptomatic responses during adenosine perfusion scintigraphy. To assess whether certain clinical conditions are responsible for this variability, change in hemodynamics and number of symptoms were correlated with multiple clinical variables in 1,934 patients (pts) receiving adenosine. Pts received adenosine 140 ~gm/kg/min x 6 rain or a graduated dose (50/75/100/140 ~tgmNg/min) x 7 rain. LV ejection fraction (EF) was available in 890 pts. The following clinical variables were associated with significant (p <.02-.001) responses to adenosine infusion compared to pts without the variable. ,1, = less change/ fewer symptoms; 1" = more change/more symptoms. Variable N AHR ASBP #Symptoms Aze->70yr 964 $ 1" - ,1, Diabetes 251 ,l, 1" $ Male 1058 $ 1" ,1, Atrial Fib. 127 ,1, 1" ,[, EF < 40% 167 $ 1" ,l, Possible mechanisms include autonomic dysfunction in diabetics and high circulating catecholamines in pts with low EF. Conclusion: There are several clinical variables which affect the hemodynamic and symptomatic responses to adenosine infusion.
To assess the diagnostic value of exercise Thallium 201 (TI) single photon emission computed tomography (SPECT) for the identification of patients (pts) with left main (LM) coronary artery stenosis (S), we studied 31 pts (mean age 60 _+ 10 years, 26 males, 5 females) with LM S > 50% who had exercise-redistribution SPECT. Twenty-seven pts had LM S associated with 1, 2 or 3 vessel disease respectively in 8, 9 and 10 pts; 21 of them had RCA S >_ 70% .Twenty-five out of 27 (93%) had a reversible TI defect (RD): 15 (52%) anterior, anteroseptal and/or apical, 3 (10%) anterolateral, 8 (26%) inferolateral, 11 (35%) inferior. The so called left main pattern was not observed. Four pts had isolated LM S: 3 had normal SPECT, 1 had a small anterior RD. Abnormal lung TI uptake was noted in 14 pts (45%) and ventricular cavity dilatation in 13 (42%). All the pts had a positive exercise test. Conclusion 9 despite its ability to detect CAD in 84% of these pts, SPECT could be normal and was not specific of left main disease. However when exercise testing data were added severe CAD could be identified.
$61-442
$61-444
REST-REDISTRIBUTION THALLIUM-201 AND R E S T M I B I S P E C T IN P A T I E N T S W I T H S T A B L E CAD: A Q U A N T I T A T I V E E V A L U A T I O N .
MYOVIEW FOR REST/STRESS MYOCARDIAL SPECT WITHIN 2 HOURS. A SPANISH-PORTUGUESE MULTICENTER TRIAL.
Claudio Marcassa, Alberto Cuocolo, Michele Galli, Simone Maurea, Marco Salvatore. Clinica del Lavoro Foundation IRCCS, Vemno (No) and Federico II Univ., Napoli, ITALY
RMontz,MJ.Perez-Castej6n,JA.Jurado,J.Martfn-Comfn,E.Esplugues, U Salgado,A.VentCysa,G.Cantinho,AT.Fonseca,MJ.Tabuenca,A.Garcfa, D.Ortega,C.Puente,Al Ferrer,JM Latre and JL Carreras. Complutense Univ.Madrid(Monitoring),7 centers in Spain and 4 centers in Portugal
Thallium-201 (T1) redistribution (RED) after resting injection reflects hypoperfused but viable myocardium. We compared resting MIBI with REST-4hr RED T1 uptake in 44 pts with documented CAD and regional asynergies (56-+10 yrs; LVEF 40-+15%). T1 and MIBI SPECT were performed on separate days; MIBI images were acquired 60 rain after injection. Tracer uptake was quantified in 22 seg/pt. In 456 seg with normal (>75% of peak activity) REST T1 uptake, MIBI uptake was preserved (86-+15%; >75% in 374/456, 82%). In 512 abnormal REST T1 seg, MIBI uptake was comparable to REST TI (50+18% vs 52+16%, p=ns) but was significantly lower than RED TI uptake (55-+18%, p< 0.01). Significant (>10% uptake increase) RED was documented in 147/512 (29%) abnormal REST T1 seg. Mean tracer uptake was: REST RED MIBI Seg. with RED (n=147) 51+17" 68-+17 54-+20":I: Seg. without RED (n=365) 52+15 49-+165 48+165 *p<.001 vs RED; $p<.05 vs REST In pts with chronic CAD and regional asynergies, MIBI activity 60 min after injection parallels RED TI activity in seg with fixed T1 defects only. Despite comparable resting T1 uptake, seg with RED had a greater 4hr T1 than MIBI uptake.
The diagnostic efficacy of 99mTc-tetrofosmin(Myoview)in patients with CAD was studied with a SPECT rest/stress protocol in 2 hours. Methods: The study included patients with diagnosis of uncomplicated CAD. With a radiochemical purity of >90%,each patient was injected with <__300MBq Myoview at rest and<9'O0MBq at peak of exercise. SPECT acquisitions were made l)at rest, and 2)with stress injection aprox. 1 hour after the rest injection. The images were read by 2 or 3 blinded experts in nuclear cardiology. The results were compared with those of coronary angiog:'aphy (CA). Results: From a total of 167 patients included, the data of 142 were completely evaluable (23 without CA, 2 with non evaluable images). Longer intervals between injection and SPECT acquisition at rest (32+ 14 min,n=82 vs. 7+4 min, n=85) did not influence significantly the diagnostic results. The quality of the rest images was excellent or good in 86%, Ix~orin 12% and non evaluable in 2~ The sensitivity(S) of SPECT to detect CAD with >75%/>50% steoosis was 96/93%, with an accuracy(A) of 82/85%. The localization of defects by SPECT in relation to perfusion territories of stenosed vessels (>75%~_50%) was achieved with S= 69/64% for LAD, 55/48% for LCX and 91/86% for RCA, with A-=-73/71%, 76/71'4~ and 64/73%. Concordances were 62% for single and 68% tk~r multiple vessel disease. Conclusions: This is the first large multicentcr clinical trial confirming the usefullness of Myoview in an ultrashort protocol (2 hours) myocardial rest/stress SPECT procedure.