Abstract
Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to under-estimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=>50% vs necrotic =≤50% of the maximal tracer activity) with a binary wall motion classification during low-dose dobutamine infusion (viable=normal/hypokinetic vs necrotic=akinetic/dyskinetic). Infarct size, expressed as the number of segments with evidence of necrotic tissue, was significantly greater in the scintigraphic study than in the echocardiographic study (2.8±1.5 vs 2.2±1.3,P=0.006). This overestimation of infarct size by99mTc-sestamibi was present only in patients with a severe infarct-related stenosis (% diameter stenosis ≽65%–100%) and particularly those with “late” reperfusion therapy (time delay ≽180 min). In patients without a severe infarct-related stenosis,99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy.
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References
Ellis S, Henschke C, Sandor T, Wynne J, Braunwald E, Kloner R. Time course of functional and biochemical recovery of myocardium salvaged by reperfusion.J Am Coll Cardiol 1983; 1: 1047–1055.
Braunwald E, Kloner R. The stunned myocardium: prolonged, postischemic ventricular dysfunction.Circulation 1982; 66: 1146–1149.
Pierard L, De Landsheere C, Berthe C, Rigo P, Kulbertus H. Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography.J Am Coll Cardiol 1990; 15: 1021–1031.
Smart S, Sawada S, Ryan T, et al. Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction.Circulation 1993; 88: 405–415.
Previtali M, Poli A, Lanzarini L, Fetiveau R, Mussini A, Ferrario M. Dobutamine stress echocardiography for assessment of myocardial viability and ischemia in acute myocardial infarction treated with thrombolysis.Am J Cardiol 1993; 72: 124G-130G.
Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being expert.J Am Coll Cardiol 1991; 17: 666–669.
Beanlands R, Dawood F, Wen W, et al. Are the kinetics of technetium-99m methoxyisobutyl isonitrile affected by cell metabolism and viability?Circulation 1990; 82: 1802–1814.
Beller G, Glover D, Edwards N, Ruiz M, Simanis J, Watson D. Tc-99m sestamibi uptake and retention during myocardial ischemia and reperfusion.Circulation 1993; 87: 2033–2042.
Beller GA, Sinusas AJ. Experimental studies of the physiologic properties of technetium-99m isonitriles.Am J Cardiol 1990; 66: 5E-8E.
Sinusas AJ, Trautman KA, Bergin JD, et al. Quantification of area at risk during coronary occlusion and degree of myocardial salvage after reperfusion with technetium-99m methoxysiobutyl isonitrile.Circulation 1990; 82: 1424–1437.
Sawada S, Allman K, Muzik O, et al. Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects.J Am Coll Cardiol 1994; 23: 92–98.
Rocco T, Dilsizian V, Strauss H, Boucher C. Technetium-99m isonitrile myocardial uptake at rest. Relation to clinical markers of potential viability.J Am Coll Cardiol 1989; 14: 1678–1684.
Marzullo P, Parodi O, Reisenhofer B, et al. Value of rest thallium-201/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability.Am J Cardiol 1993; 71: 166–172.
Marzullo P, Sambuceti G, Parodi O. The role of sestamibi sctinigraphy in the radioisotopic assessment of myocardial viability.Nucl Med 1992; 33: 1925–1930.
Baer F, Smolarz K, Theissen P, Voth E, Schicha H, Sechtem U. Regional Tc-99m methoxyisobutyl-isonitrile uptake at rest in patients with myocardial infarcts: comparison with morphological and functional parameters obtained from gradient-echo magnetic resonance imaging.Eur Heart J 1994; 15: 97–107.
Altehoefer C, Kaiser H, Dorr R, et al. Fluorine-18 deoxyglucose PET for assessment of viable myocardium in perfusion defects in Tc-99m MIBI SPET: a comparative study in patients with coronary artery disease.Eur J Nucl Med 1992; 19: 334–342.
Serruys W, Zijlstra F, Laarman G, Reiber H, Beatt K, Roelandt J. A comparison of two methods to measure coronary flow reserve in the setting of coronary angioplasty: intracoronary blood flow velocity measurements with a Doppler catheter, and digital subtraction cineangiography.Eur Heart J 1989; 10: 725–736.
Panza J, Dilsizian V, Laurienzo R, Curiel R, Katsiyiannis P. Relation between thallium uptake and contractile response to dobutamine: implications regarding myocardial viability in patients with chronic coronary artery disease and left ventricular dysfunction.Circulation 1995; 91: 990–998.
Gould K, Lipscomb K. Effects of coronary stenosis on coronary flow reserve and resistance.Am J Cardiol 1974; 34: 48–55.
Bisi G, Sciagra R, Santoro G, Fazzine P. Rest technetium-99m sestamibi tomography in combination with short-term administration of nitrates: feasibility and reliability for prediction of postrevascularization outcome of asynergic territories.J Am Coll Cardiol 1994; 24: 1282–1289.
Ito H, Tomooka T, Sakai N, et al. Lack of myocardial perfusion immediately after successful thrombolysis: a poor predictor of poor recovery of left ventricular function in anterior myocardial infarction.Circulation 1992; 85: 1699–1705.
Bolli R, Triana J, Jeroudi M. Prolonged impairment of coronary vasodilation after reversible ischemia. Evidence for microvascular “stunning”.Circ Res 1990; 67: 332–343.
Kloner R, Rude R, Carlson N, Maroko P, De Boer L, Braunwald E. Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: Which comes first?Circulation 1980; 62: 945–952.
Galli M, Marcassa C, Bolli R, et al. Spontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction: evidence for the presence of hibernating myocardium in the infarcted area.Circulation 1994; 90: 1386–1397.
Pellikka P, Behrenbeck T, Veram M, et al. Serial changes in myocardial perfusion using tomographic technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging following reperfusion therapy of myocardial infarction.J Nucl Med 1990; 31: 1269–1275.
Sinusas A, Shi Q, Vitols P, et al. Impact of regional ventricular function, geometry, and dobutamine stress on quantitative Tc-99m sestamibi defect size.Circulation 1993; 88: 2224–2234.
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Claeys, M.J., Rademakers, F.E., Vrints, C.J. et al. Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis. Eur J Nucl Med 23, 748–755 (1996). https://doi.org/10.1007/BF00843702
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DOI: https://doi.org/10.1007/BF00843702