Regional concordance and discordance between rest thallium 201 and sestamibi imaging for assessing tissue viability: Comparison with postrevascularization functional recovery

doi:10.1016/S1071-3581(05)80075-3

Journal of Nuclear Cardiology

Volume 2, Issue 4, July–August 1995, Pages 309-316

https://doi.org/10.1016/S1071-3581(05)80075-3 Get rights and content

Abstract

Background.

Whether the combined analysis of rest ²⁰¹Tl and sestamibi uptake provides additional information regarding myocardial viability in patients with coronary artery disease is still to be investigated.

Methods and Results.

To this aim we studied 22 patients with previous myocardial infarction and regional ventricular dysfunction by quantitative rest sestamibi and ²⁰¹Tl scintigraphy. All patients underwent revascularization, and echocardiography was repeated 11±2 weeks later. Concordant results were obtained in 80 of 105 dyssynergic segments. Fifty-one segments showed normal and 29 abnormal activity. Follow-up echocardiography showed increased wall motion contractility in 76% of segments with maintained ²⁰¹Tl and sestamibi uptake and in only 17% of segments characterized by subthreshold activities. Twenty-five segments, or 24%, showed sestamibi/²⁰¹Tl mismatch. Eleven of 12 segments with normal sestamibi/abnormal ²⁰¹Tl activity did not improve after revascularization, whereas 11 of 13 segments with abnormal sestamibi but normal ²⁰¹Tl showed postoperative improvement of regional wall motion.

Conclusions.

In patients with previous myocardial infarction, sestamibi and ²⁰¹Tl showed concordant results in most segments. However, in segments with mismatch a maintained sestamibi uptake was a poor indicator of tissue viability, whereas significant ²⁰¹Tl uptake reflected tissue viability in most segments.

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Prediction of left ventricular wall motion recovery after acute myocardial infarction by Tl-201 gated SPECT: Incremental value of integrated contractile reserve assessment
2002, Journal of Nuclear Cardiology
Background. This investigation tested the application of low-dose dobutamine (LDD) gated single photon emission computed tomography (SPECT) with thallium 201 for myocardial viability detection early after acute myocardial infarction (AMI). Methods and Results. Thirty-two hemodynamically stable post-AMI patients (aged 55 ± 5 years [mean ± SEM]; 20 men) who were exhibiting regional left ventricular dysfunction underwent stress-redistribution Tl-201 scanning within 4 to 8 days, followed by 2 additional gated SPECT acquisitions after Tl-201 reinjection, at rest and during LDD. A visual 5-point score was computed for segmental radiotracer uptake (0, normal; 4, absent) and a 4-point score for left ventricular wall motion (1, normal; 4, dyskinesis). Predominant viable myocardium in dyssynergic regions was predicted by a mean Tl-201 uptake score of 2 or less or ischemic area of 30% or greater. These indices showed a significant association with wall motion improvement in follow-up echocardiographic studies (overall accuracy = 0.69, sensitivity = 0.93, and specificity = 0.50). Regarding the response to LDD stimulus, an increase in mean wall motion score of 30% or greater was predictive of predominant viable myocardium. Contractile reserve assessment yielded a significant increment in the predictive accuracy for function recovery (overall accuracy = 0.84, sensitivity = 0.71, and specificity = 0.94). Conclusions. Evaluation of contractile reserve by means of LDD gated SPECT with Tl-201 is safely feasible early after AMI, with incremental value over perfusion assessment alone for myocardial viability detection. (J Nucl Cardiol 2002;9:294-303.)
Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium
2001, Current Problems in Cardiology
Technetium 99m furifosmin regional myocardial uptake in patients with previous myocardial infarction: Relation to thallium-201 activity and left ventricular function
2000, Journal of Nuclear Cardiology
Background. This study was designed to compare the results of rest-redistribution thallium-201 imaging with those of rest technetium 99m furifosmin single photon emission computed tomography in the same patients with chronic ischemic left ventricular (LV) dysfunction. Methods. Twenty-one patients (mean age 62 ± 9 years) with chronic myocardial infarction and LV dysfunction (mean LV ejection fraction 34% ± 8%) underwent rest-redistribution thallium imaging and resting furifosmin single photon emission computed tomography on the same day. In each patient, regional thallium and furifosmin activity was quantitatively measured in 13 myocardial segments. Regional LV function was assessed in corresponding segments by echocardiography. Results. At thallium imaging, 91 (33%) segments had normal uptake, 16 (6%) showed reversible defects, and the remaining 166 (61%) irreversible defects. Of these 166 irreversible defects, 74 (45%) had moderate (≥58% of peak activity) and 92 (55%) severe (<58% of peak activity) reduction of thallium uptake. Regional furifosmin uptake was significantly related to both rest (r = 0.87, P < .0001) and redistribution (r = 0.90, P < .0001) thallium activity. Agreement in the evaluation of regional perfusion status between thallium and furifosmin imaging was observed in 70% of the 84 hypokinetic segments (κ = 0.54) and in 76% of the 78 akinetic or dyskinetic segments (κ = 0.60). Concordance in the detection of myocardial viability between thallium and furifosmin imaging was observed in 69 (82%) of hypokinetic regions (κ = 0.60) and in 65 (83%) of akinetic or dyskinetic regions (κ = 0.67). Conclusions. These results suggest that in patients with chronic coronary artery disease and LV dysfunction, quantitative rest-redistribution thallium scintigraphy and furifosmin tomography at rest provide similar results in the evaluation of perfusion status and in the detection of myocardial viability. (J Nucl Cardiol 2000;7:235–41.)
Use of standard imaging techniques for prediction of postrevascularization functional recovery in patients with heart failure
1999, Journal of Cardiac Failure
Improved detection of myocardial perfusion reversibility by rest-nitroglycerin Tc-99m-MIBI: Comparison with Tl-201 reinjection
1999, Journal of Nuclear Cardiology
Background. The role of nitroglycerin (NTG) in Tc-99m-methoxyisobutil isonitrile (MIBI) studies to improve the assessment of myocardial viability in patients with coronary artery disease and its comparison with Tl-201 reinjection has not yet been clarified. This study aimed to test whether sublingual administration of NTG could improve the capability of Tc-99m-MIBI to detect reversibility in exercise-induced perfusion defects and to compare it with the Tl-201 stress-redistribution-reinjection protocol.
Methods and Results. Thirty-eight patients (33 men, 5 women; mean age 49.3 ± 8.2 years with previous myocardial infarction [mean evolution 7.1 ± 3.9 months]) underwent exercise, redistribution, and reinjection Tl-201 imaging, as well as exercise, rest, and NTG MIBI myocardial scintigraphy (3-day protocol). A total of 494 myocardial segments were assessed by quantitative analysis. Of the 136 myocardial segments with fixed defects on exercise-rest sestamibi imaging, 109 (80%) did not change after NTG MIBI study, and 27 (20%) demonstrated enhanced uptake. In the 140 myocardial segments with fixed defects on exercise-redistribution thallium imaging, 112 (80%) did not improve after Tl-201 reinjection study, and 28 (20%) showed increased activity. The observed agreement on reversibility detection between NTG MIBI and Tl-201 reinjection, with the 210 segments with perfusion defects used for this analysis on both studies, was 78%, with a significant kappa = .56 ± .07 SE.
Conclusion. Our data suggest that the use of an NTG MIBI protocol results in an incremental improvement for detecting exercise-induced perfusion defect reversibility and achieves results similar to those from a Tl-201 reinjection protocol.
Functional assessment with electrocardiographic gated single-photon emission computed tomography improves the ability of technetium-99m sestamibi myocardial perfusion imaging to predict myocardial viability in patients undergoing revascularization
1999, American Journal of Cardiology
This study evaluates the use of electrocardiographic (ECG) gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging for the prediction of viability in patients undergoing revascularization, who have coronary disease and left ventricular dysfunction. Fifty patients underwent technectium-99m (Tc-99m) sestamibi ECG gated SPECT imaging preoperatively at rest and 1 week after revascularization, whereas 36 (72%) also underwent imaging 6 weeks after revascularization. Images were interpreted by the consensus of 3 experienced readers without knowledge of patient identity or time of imaging (pre- or postrevascularization) for perfusion and wall motion using a 17-segment model. Results of perfusion alone were compared with perfusion and wall motion combined. One hundred five coronary artery territories were revascularized, 96 of which were viable and 9 nonviable. Perfusion alone predicted 87 to be viable and 18 nonviable (sensitivity 86%, specificity 55%, positive predictive value 95%, negative predictive value 28%, and overall accuracy 85%). Perfusion and wall motion combined identified 95 territories to be viable (sensitivity 95%; p <0.025; specificity 55%, positive predictive value 96%, negative predictive value 50%, and overall accuracy 91%; p <0.05). Thus, Tc-99m sestamibi ECG gated SPECT myocardial perfusion imaging at rest allows assessment of both perfusion and wall motion, which significantly improves the sensitivity and overall accuracy for determination of viability in comparison with perfusion alone.

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⁺: Supported in part by CNR-targeted project Prevention and Control Disease Factors, subproject Control of Cardiovascular Disease, from the National Research Council, Rome, Italy, and by Ministero Pubblica, Istruzione, Italy.

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Original articleRegional concordance and discordance between rest thallium 201 and sestamibi imaging for assessing tissue viability: Comparison with postrevascularization functional recovery+

Abstract

Background.

Methods and Results.

Conclusions.

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

The role of sestamibi scintigraphy in the radioisotopic assessment of myocardial viability

J Nucl Med

Identification of viable myocardium in patients with chronic coronary artery disease: comparison of thallium-201 scintigraphy and technetium-99m-methoxyisobutyl isonitrile

J Nucl Med

Original article
Regional concordance and discordance between rest thallium 201 and sestamibi imaging for assessing tissue viability: Comparison with postrevascularization functional recovery+