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The value of myocardial perfusion scintigraphy (MPS) in angiographically proven coronary artery disease (CAD)
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Abstracts Tuesday morning, April 25, 1995
J O U R N A L OF N U C L E A R C A R D I O L O G Y
March/April 1995, Part 2
P09-245
P 10-247
T H E VALUE OF MYOCARDIAL PERFUSION SUIN'rlGRAPBY (MPS) IN ANGIOGRAPHICALLY PROVEN CORONARY ARTERY DISEASE (CAD) G. Walsh, G.C. Viv~e~, C.J. Burrell, A.J. Marshall Derriford HospRal~ PI)mouth, United Kingdom
Rodionnr
The ~hoice between i n t e r v e n t i o n and medical management in pati~mts w i t h C,~D depends on the signiiieanee of the stenoses. We have investigated the influence of MPS on managemea~t of patienls with multiple legions demoogc.~ted on coronary angiography (CAG). From November 1992 to Novea~_b~ I993, 38 pati~alts '~ere referred for M r s following CAG These patients bad multiple m~o~aN~ie stenoses of severity 40-70% and the influence of these lesions on myocardial peffusion was not eer~ain. 400 ml3q T o 9 9 m MIBI were injected at rest stud s~'ess (2-day proloeol) 180" SPECT acquisitions were made using an IGE 400 ACT Gamma camera and processed on Nuclear Dia~aostic~ Garm~a I! computer. Studies were analysed visually and with a bull's eye projection. UAG lesions were assessed visually.
A~tthors:
ImagingScorein Post M1 Patients S. ||tw~ien Omar; M.S. M~khtar, M.D.; W. Radwsm, M.D.; G. Ziada, M,D.
To asse.s~the value of radinnuolide lmagin8 in stratifying patientsalter ~cute Myocardial Infarction (MI), we studied 3h paliea~ (33 male, 3 female, mean age 46) at an average of 26 week~ Oange 24 to 50 weeks) post MI which was tnterlot in 24 and inferior in 12 p~. Infarct size was asseseed by I~KG(QRS Selve~r looting system) sad Echo scoring system, patients were subjected to myoeantial perf~inn stre~s and r~t hnaging ~in~ Thidlinm-201, Image~ wer~ ~ly~ed vmually after dMding ~h~ |oR ventt/cle into 20 eegmen~ end with the degree of perfu~ion exprea~ed on a scale of 0-4 with a figure given to e~ch ~egment~o~ding te its degree of perfl~ion and final scc~r~ wan calculatedfor both rest mid stxe~. An arbltr~ score of 6 could identifyt~o group~ of patients regardh~g cardiac events (angina, MI eaadheart fai|ufe) which could not be di~imgui~hed onEKG emd Echo sco~g. Number of segmentwlthpermeneaRdefect 6and reven~ib!esegmemts -< 3 wasslgnificlmtlyprediefiveofprognosls. Survlveleurve4 showed the difference. &
'~'~ I t~'l,
.... I .... I"~ 3 I"~ I . ~ "
I"
An61na
I
1[
io
2
2
18
5
"1
Ile~rt Failure
8
2
2
6
8
2
l0
I
16
20
R~u~ 2 11 7 8 7
T U E S D
CAG Normal l/2 Vessel 1/2 Vessel 2/3 Vessel Post CABO/PTCA
l~.q Normal Normal 1 Vessel 2/3 Vessel 3 Normal 3 '1 Vessel' 1 '3 Vessel'
TREATMENT None Medical PTCA CABG Medical PTCA Repeat CABG
2 patienk~ were inadequately stressed and MPS tmdetestimated disease extent in I case. Conciuskm MrS is a useful adjunct to CAG with si~ifieant m3plieations for patient management.
A Y
MI Total Patl~tt
I
9
16
I
24
12
1
22
14
1
Patien~ were also subjected to multigated ro.Aionucllde stodle~ both at r~ and after Dobutsmiae (gradual incremeut in dose from 5 to max. of 40 uc/kghnin, we~ used). Ejection Fraction (EF) at rest end with etre~s, maxlmmn fitti~ end emptyln8 r~t~, ptuteeangle for r ~ oaul styea~~md ejec~tionfraction difference between stress erel ~ t ( ~ EF) ,~ere caicul~e:d. An ~rbitr~' flg~e of 8 for ( ~ EF) coukl identify 3 groups of pts accotxlingto the occurte.nce of c~rdiac events (Angina, MI) ~ well ~.l~e~gl failorr ( H ~ . In conclusion, spear scoringprovides u ~ef~l uon-inve~ive tool in stratlfyiai post M1 gatient&Radinnuelldr ventrlcu|og~phy using muRigated cardiac blood pool imaging could clearly dletinguish pm with unfavoorable outcome after MI with signific~a~tlyhigher incidence of cardlac events for those having ~ EF difference ~ g % compared to those obove 8%.
P M A P R I L
P09-246
P10-248
Tc-99m MIBI MYOCARDIAL PERFUSION SCINTIGRAPNY IN LEFT BUNDLE BRANCH BLOCK (LBBB) A EIImann, BB van Heerden, PDR van Heerden, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa In patients with LBBB TI-201 stress perfusion scintigraphy often detects a false positive ischaemic pattern in the interventricular septum. The aim of this retrospective study was to determine the scintigraphic appearance in LBBB with SPECT using Tc-99m MIBI. We studied 51 patients with LBBB, referred for routine MIBI stress-rest SPECT. Studies were evaluated b)/ visual analysis and the Cedars Sinai grading protocok Ischaemic heart disease was confirmed or excluded by angiography or clinically. Normal studies were obtained in 28 of the 51 patients (55%). Thirteen patients had abnormalities only in areas other than the septum, while 10 patients had septal defects. Of these, 36 of the 80 septal segments were involved - 15 irreversible. In the remaining 21 segments (7151 patients) the stress and rest studies differedby 2 or more grades indicating reversible ischaemia. This represents only 5% of the total number of septa segments. With the exception of 1 patient, ischaemic heart disease was proven. Our results show that with MIBI, in contrast to TI-201, reversible perfusion defects in the septum a r e seen only in a minority of patients with LBBB on myocardial perfusion scintigraphy . Alt these patients had proven ischaemic heart disease. Therefore the septal changes indicate true positive results, Tc-99m MIBI is a better nBYBocardialperfusion agent than TI-201 in patients with B
PROGNOSTIC EVALUATION AFTER MYOCARDIAL INFARCT (MI):INCREMENTAL VALUE OF MIBI-SPECT AND ECHO, P Zanco, A Zampiero,A Favero,N Borsato, PG Piovesana,D Rubello and G F e r l i n , Nuclear MedicineCastelfranco V and Cardiology-Camposampiero,ITA To compare the r o l e of d i f f e r e n t c l i n i c a l f i n d ings and instrumental techniques in r i s k s t r a t i f i c a t i o n o f MI pts,86 pts affected by a MI occur Pin 9 at l e a s t 3 mo b e f o r e ( 8 2 m , 4 f , aged 2 7 - 6 8 y r s ) were submitted to stress-rest MIBI SPECT and to echo,calculating wall motion index(WMi)and the ejection fraction(EF).Age, gender,risk factors f o r CAD,angina,stress double product and heart rate,ST depression during stress were also included in the analysis.The ensuing cardiac events(CE)were recomded;the minimum f o l l o w up was 4yrs(range 48-72mo,mean 55).At the m u l t i v a r i a t e analysis a r e v e r s i b l e defect on MIBI SPECT (p= 0,014),a low EF(p=0.015),a NMI superior to 1.4 (p=0.024)and angina(p=0.034)were s i g n i f i c a n t and independent prognostic factors of ensuing CE. Thus, in our experience,both NIBI SPECTand echo proved to be fundamental p r o g n o s t i c t o o l s in risk stratification o f p a t i e n t s with myocardial infarction.
Abstracts Tuesday morning, April 25, 1995
J O U R N A L OF N U C L E A R C A R D I O L O G Y
March/April 1995, Part 2
P09-245
P 10-247
T H E VALUE OF MYOCARDIAL PERFUSION SUIN'rlGRAPBY (MPS) IN ANGIOGRAPHICALLY PROVEN CORONARY ARTERY DISEASE (CAD) G. Walsh, G.C. Viv~e~, C.J. Burrell, A.J. Marshall Derriford HospRal~ PI)mouth, United Kingdom
Rodionnr
The ~hoice between i n t e r v e n t i o n and medical management in pati~mts w i t h C,~D depends on the signiiieanee of the stenoses. We have investigated the influence of MPS on managemea~t of patienls with multiple legions demoogc.~ted on coronary angiography (CAG). From November 1992 to Novea~_b~ I993, 38 pati~alts '~ere referred for M r s following CAG These patients bad multiple m~o~aN~ie stenoses of severity 40-70% and the influence of these lesions on myocardial peffusion was not eer~ain. 400 ml3q T o 9 9 m MIBI were injected at rest stud s~'ess (2-day proloeol) 180" SPECT acquisitions were made using an IGE 400 ACT Gamma camera and processed on Nuclear Dia~aostic~ Garm~a I! computer. Studies were analysed visually and with a bull's eye projection. UAG lesions were assessed visually.
A~tthors:
ImagingScorein Post M1 Patients S. ||tw~ien Omar; M.S. M~khtar, M.D.; W. Radwsm, M.D.; G. Ziada, M,D.
To asse.s~the value of radinnuolide lmagin8 in stratifying patientsalter ~cute Myocardial Infarction (MI), we studied 3h paliea~ (33 male, 3 female, mean age 46) at an average of 26 week~ Oange 24 to 50 weeks) post MI which was tnterlot in 24 and inferior in 12 p~. Infarct size was asseseed by I~KG(QRS Selve~r looting system) sad Echo scoring system, patients were subjected to myoeantial perf~inn stre~s and r~t hnaging ~in~ Thidlinm-201, Image~ wer~ ~ly~ed vmually after dMding ~h~ |oR ventt/cle into 20 eegmen~ end with the degree of perfu~ion exprea~ed on a scale of 0-4 with a figure given to e~ch ~egment~o~ding te its degree of perfl~ion and final scc~r~ wan calculatedfor both rest mid stxe~. An arbltr~ score of 6 could identifyt~o group~ of patients regardh~g cardiac events (angina, MI eaadheart fai|ufe) which could not be di~imgui~hed onEKG emd Echo sco~g. Number of segmentwlthpermeneaRdefect 6and reven~ib!esegmemts -< 3 wasslgnificlmtlyprediefiveofprognosls. Survlveleurve4 showed the difference. &
'~'~ I t~'l,
.... I .... I"~ 3 I"~ I . ~ "
I"
An61na
I
1[
io
2
2
18
5
"1
Ile~rt Failure
8
2
2
6
8
2
l0
I
16
20
R~u~ 2 11 7 8 7
T U E S D
CAG Normal l/2 Vessel 1/2 Vessel 2/3 Vessel Post CABO/PTCA
l~.q Normal Normal 1 Vessel 2/3 Vessel 3 Normal 3 '1 Vessel' 1 '3 Vessel'
TREATMENT None Medical PTCA CABG Medical PTCA Repeat CABG
2 patienk~ were inadequately stressed and MPS tmdetestimated disease extent in I case. Conciuskm MrS is a useful adjunct to CAG with si~ifieant m3plieations for patient management.
A Y
MI Total Patl~tt
I
9
16
I
24
12
1
22
14
1
Patien~ were also subjected to multigated ro.Aionucllde stodle~ both at r~ and after Dobutsmiae (gradual incremeut in dose from 5 to max. of 40 uc/kghnin, we~ used). Ejection Fraction (EF) at rest end with etre~s, maxlmmn fitti~ end emptyln8 r~t~, ptuteeangle for r ~ oaul styea~~md ejec~tionfraction difference between stress erel ~ t ( ~ EF) ,~ere caicul~e:d. An ~rbitr~' flg~e of 8 for ( ~ EF) coukl identify 3 groups of pts accotxlingto the occurte.nce of c~rdiac events (Angina, MI) ~ well ~.l~e~gl failorr ( H ~ . In conclusion, spear scoringprovides u ~ef~l uon-inve~ive tool in stratlfyiai post M1 gatient&Radinnuelldr ventrlcu|og~phy using muRigated cardiac blood pool imaging could clearly dletinguish pm with unfavoorable outcome after MI with signific~a~tlyhigher incidence of cardlac events for those having ~ EF difference ~ g % compared to those obove 8%.
P M A P R I L
P09-246
P10-248
Tc-99m MIBI MYOCARDIAL PERFUSION SCINTIGRAPNY IN LEFT BUNDLE BRANCH BLOCK (LBBB) A EIImann, BB van Heerden, PDR van Heerden, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa In patients with LBBB TI-201 stress perfusion scintigraphy often detects a false positive ischaemic pattern in the interventricular septum. The aim of this retrospective study was to determine the scintigraphic appearance in LBBB with SPECT using Tc-99m MIBI. We studied 51 patients with LBBB, referred for routine MIBI stress-rest SPECT. Studies were evaluated b)/ visual analysis and the Cedars Sinai grading protocok Ischaemic heart disease was confirmed or excluded by angiography or clinically. Normal studies were obtained in 28 of the 51 patients (55%). Thirteen patients had abnormalities only in areas other than the septum, while 10 patients had septal defects. Of these, 36 of the 80 septal segments were involved - 15 irreversible. In the remaining 21 segments (7151 patients) the stress and rest studies differedby 2 or more grades indicating reversible ischaemia. This represents only 5% of the total number of septa segments. With the exception of 1 patient, ischaemic heart disease was proven. Our results show that with MIBI, in contrast to TI-201, reversible perfusion defects in the septum a r e seen only in a minority of patients with LBBB on myocardial perfusion scintigraphy . Alt these patients had proven ischaemic heart disease. Therefore the septal changes indicate true positive results, Tc-99m MIBI is a better nBYBocardialperfusion agent than TI-201 in patients with B
PROGNOSTIC EVALUATION AFTER MYOCARDIAL INFARCT (MI):INCREMENTAL VALUE OF MIBI-SPECT AND ECHO, P Zanco, A Zampiero,A Favero,N Borsato, PG Piovesana,D Rubello and G F e r l i n , Nuclear MedicineCastelfranco V and Cardiology-Camposampiero,ITA To compare the r o l e of d i f f e r e n t c l i n i c a l f i n d ings and instrumental techniques in r i s k s t r a t i f i c a t i o n o f MI pts,86 pts affected by a MI occur Pin 9 at l e a s t 3 mo b e f o r e ( 8 2 m , 4 f , aged 2 7 - 6 8 y r s ) were submitted to stress-rest MIBI SPECT and to echo,calculating wall motion index(WMi)and the ejection fraction(EF).Age, gender,risk factors f o r CAD,angina,stress double product and heart rate,ST depression during stress were also included in the analysis.The ensuing cardiac events(CE)were recomded;the minimum f o l l o w up was 4yrs(range 48-72mo,mean 55).At the m u l t i v a r i a t e analysis a r e v e r s i b l e defect on MIBI SPECT (p= 0,014),a low EF(p=0.015),a NMI superior to 1.4 (p=0.024)and angina(p=0.034)were s i g n i f i c a n t and independent prognostic factors of ensuing CE. Thus, in our experience,both NIBI SPECTand echo proved to be fundamental p r o g n o s t i c t o o l s in risk stratification o f p a t i e n t s with myocardial infarction.