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Selective intracoronary injection of sestamibi to detect myocardial viability: Prediction of perfusion and contractile recovery after percutaneous transluminal coronary angioplasty.
- Source :
-
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology [J Nucl Cardiol] 2003 Sep-Oct; Vol. 10 (5), pp. 473-81. - Publication Year :
- 2003
-
Abstract
- Background: The main limitation of myocardial single photon emission computed tomography (SPECT) in detecting hibernating myocardium is the poor delivery of radiotracers in hypoperfused areas supplied by severely stenotic coronary arteries. Increasing local availability of radiotracers by intracoronary injection might represent an attractive solution. The hypothesis that the intracoronary administration of sestamibi could improve myocardial SPECT accuracy in detecting hibernating myocardium was addressed in this pilot study.<br />Methods and Results: Seven patients with prior myocardial infarction and severe stenosis of the infarct-related artery underwent myocardial SPECT after intracoronary injection of technetium 99m sestamibi immediately before percutaneous transluminal coronary angioplasty (PTCA). Wall motion and perfusion were evaluated, before and 1 month after PTCA, by 2-dimensional echocardiography and rest-redistribution thallium 201 SPECT. A "low-flow area" was identified on the pre-PTCA Tl-201 SPECT image as the area with less than 50% of maximum radiotracer uptake. Changes in wall motion and perfusion in the low-flow area were compared with results of intracoronary sestamibi imaging. On a pixel-by-pixel analysis, intracoronary sestamibi predicted perfusion recovery within the low-flow area with a 91% sensitivity, a 78% specificity, and an 82% overall accuracy. Only in the 5 patients with an extent of sestamibi uptake greater than one third of the low-flow area was an improved regional and global left ventricular wall motion observed after PTCA (wall motion score index decreased from 1.95 +/- 0.28 to 1.60 +/- 0.34, P =.007; left ventricular ejection fraction increased from 42% +/- 7% to 49% +/- 7%, P =.001; asynergic segments in the low-flow area decreased from 3.6 +/- 0.9 to 1.8 +/- 1.5, P =.021).<br />Conclusions: In patients with prior myocardial infarction and severe stenosis of the infarct-related artery, sestamibi uptake after intracoronary administration identified viable myocardium that was undetected after rest-redistribution thallium SPECT but capable of clinically significant contractile improvement after revascularization.
- Subjects :
- Adult
Aged
Carotid Stenosis diagnosis
Carotid Stenosis etiology
Female
Humans
Male
Middle Aged
Myocardial Contraction
Myocardial Infarction complications
Myocardial Infarction diagnosis
Myocardial Infarction diagnostic imaging
Myocardial Infarction therapy
Pilot Projects
Prognosis
Radiopharmaceuticals administration & dosage
Recovery of Function
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume
Tissue Survival
Tomography, Emission-Computed, Single-Photon methods
Treatment Outcome
Ventricular Dysfunction, Left diagnosis
Ventricular Dysfunction, Left etiology
Ventricular Dysfunction, Left therapy
Angioplasty, Balloon, Coronary
Carotid Stenosis diagnostic imaging
Carotid Stenosis therapy
Coronary Vessels diagnostic imaging
Injections, Intra-Arterial methods
Technetium Tc 99m Sestamibi administration & dosage
Ventricular Dysfunction, Left diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1071-3581
- Volume :
- 10
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 14569240
- Full Text :
- https://doi.org/10.1016/s1071-3581(03)00522-1