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Tc-99m tetrofosmin tomography after nitrate administration in patients with ischemic left ventricular dysfunction: Relation to metabolic imaging by PET

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background. In patients with ischemic left ventricular (LV) dysfunction, myocardial perfusion imaging after nitrate administration may improve the identification of dysfunctional but viable myocardium. This study was designed to assess the relationship between tetrofosmin uptake after nitrate administration and metabolic activity as assessed by positron emission tomography (PET) in patients with ischemic LV dysfunction.

Methods and Results. Thirty-six patients with chronic myocardial infarction and LV dysfunction (ejection fraction, 35% ± 6%) underwent resting technetium 99m tetrofosmin single photon emission computed tomography (SPECT) imaging under control conditions (baseline) and after sublingual administration of 10 mg isosorbide dinitrate. Within 1 week, all patients underwent metabolic PET imaging with fluorine 18-fluorodeoxyglucose. Tetrofosmin uptake and metabolic activity were measured in 13 segments/patient. Regional LV function was assessed in corresponding segments by echocardiography. On baseline tetrofosmin imaging, 53 (40%) of the 131 akinetic or dyskinetic segments had reduced (<55% of peak activity) tracer uptake. Of these segments, 14 (26%) showed enhanced tetrofosmin uptake after nitrate administration (≥10% vs baseline) and the remaining 38 (74%) did not change. The sensitivity and specificity of baseline tetrofosmin SPECT for detecting preserved metabolic activity were 69% and 86%, respectively. After nitrate administration, the sensitivity was higher (81%, P < .05 vs baseline) whereas the specificity was not different (86%, P = not significant). Concordance between tetrofosmin SPECT and PET in differentiating viable and necrotic myocardium was observed in 94 (72%) of the 131 akinetic or dyskinetic segments at baseline (k = 0.35) and in 108 segments (82%) after nitrate administration (k = 0.53).

Conclusions. After nitrate administration, tetrofosmin uptake in dysfunctional segments correlated with metabolic activity as assessed by fluorodeoxyglucose PET imaging better than baseline. Thus tetrofosmin SPECT after nitrate administration may improve the identification of ischemic but still viable myocardium in patients with chronic ischemic LV dysfunction. (J Nucl Cardiol 2003;10:599-606.)

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Authors and Affiliations

  1. Department of Biomorphological and Functional Sciences, University Federico II, Italy

    Wei He, Wanda Acampa, Ciro Mainolfi, Francesco Menna & Anna Rita Sorrentino

  2. Institute of Biostructure and Bioimages of the National Council of Research, University Federico II, Napoli

    Wanda Acampa

  3. Dipartimento di Scienze Biomorfologiche e Funzionali, Universita` Federico II, Via Pansini, 5, 80131, Napoli, Italy

    Anna Rita Sorrentino & Alberto Cuocolo

  4. Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Italy

    Mario Petretta

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  1. Wei He
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  2. Wanda Acampa
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Correspondence to Alberto Cuocolo.

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He, W., Acampa, W., Mainolfi, C. et al. Tc-99m tetrofosmin tomography after nitrate administration in patients with ischemic left ventricular dysfunction: Relation to metabolic imaging by PET. J Nucl Cardiol 10, 599–606 (2003). https://doi.org/10.1016/S1071-3581(03)00649-4

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  • DOI: https://doi.org/10.1016/S1071-3581(03)00649-4

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