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Comparison of sestamibi, thallium, echocardiography and PET for the detection of hibernating myocardium

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Abstract

The detection of hibernating myocardium is important because revascularisation results in improved function and prognosis in patients with hibernation but not in those with non-viable myocardium. The primary aim of this study was to compare the diagnostic accuracy of four techniques with respect to hibernation in the same study population with 6–12 months of follow-up. Twenty-five males underwent rest-stress sestamibi and delayed (>18 h) thallium scintigraphy, high-dose dobutamine stress echocardiography and nitrogen-13 ammonia/fluorine-18 fluorodeoxyglucose (NH3/FDG) positron emission tomography (PET). The pre-operative ejection fraction was 36.2% (±7.3%). Follow-up was 8.1 (±2.8) months. Using postoperative improvement in wall motion on echocardiography as the gold standard, 6/34 dysfunctional vascular territories were hibernating. The mean uptake of all tracers was significantly higher in hibernating than in non-viable territories (P<0.05). Normal perfusion or mismatch on PET (FDG>NH3 uptake) and the pattern of response to dobutamine on echocardiography were also predictive of recovery (P<0.001 and P=0.02 respectively). Univariate logistic regression identified sestamibi, ammonia and FDG as independent predictors of hibernation. FDG-PET was, however, the only independent predictor using multivariate analysis. The nuclear techniques had high negative predictive values (NPV) of ≥95% but lower positive predictive values (PPV) of 45%–75% as compared with echocardiography, which had an NPV of 87% and a PPV of 100%. PET was the most powerful predictor of hibernation although the combination of a technique with a high PPV (echocardiography) and a high NPV (PET or sestamibi) may represent the optimal clinical choice.

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Acknowledgements

Dr. Barrington was kindly supported as Clinical Fellow by the Private Patients Plan Charitable Trust.

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Authors and Affiliations

  1. Clinical PET Centre, Guys and St Thomas’s Hospitals, London, SE1 7EH, UK

    S. F. Barrington, W. A. Hallett, M. J. O’Doherty & T. O. Nunan

  2. Cardiothoracic Centre, Guys and St Thomas’s Hospitals, London, UK

    J. Chambers & J. C. Roxburgh

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  1. S. F. Barrington
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  2. J. Chambers
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Correspondence to S. F. Barrington.

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Barrington, S.F., Chambers, J., Hallett, W.A. et al. Comparison of sestamibi, thallium, echocardiography and PET for the detection of hibernating myocardium. Eur J Nucl Med Mol Imaging 31, 355–361 (2004). https://doi.org/10.1007/s00259-003-1369-9

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  • DOI: https://doi.org/10.1007/s00259-003-1369-9

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