Assessment of Myocardial Viability With
            <sup>99m</sup>
            Tc Sestamibi in Patients Undergoing Cardiac Transplantation

Medrano, Rafael; Lowry, Richard W.; Young, James B.; Weilbaecher, Donald G.; Michael, Lloyd H.; Afridi, Imran; He, Zuo Xiang; Mahmarian, John J.; Verani, Mario S.

doi:10.1161/01.cir.94.5.1010

Cited by 115 publications

(34 citation statements)

References 44 publications

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“…SPECT imaging using tc-99m-sestamibi is the most widely studied technique to evaluate myocardial salvage and infarct size, having been shown to correlate with global and regional left ventricular function and volumes after STEMI, [27][28][29][30][31] clinical outcomes after reperfusion therapy (including early and late mortality and heart failure), [31][32][33][34][35][36] and pathologically with the extent of fibrosis in human hearts. 32,37 In this study, the absolute reduction in infarct size with SSO 2 was greatest in patients with the greatest clinical need-those with the largest infarctions in whom the prognosis is known to be poor despite successful PCI. 2,38 Although the median reduction in infarct size with SSO 2 was 6.5% in the entire study population, the median infarct size in patients with a baseline LVEF of Ͻ40% was decreased from a median of 33.5% with control to 23.5% with SSO 2 , representing incremental salvage of 10% of the left ventricular myocardium.…”

Section: Discussionmentioning

confidence: 68%

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Stone

Martin

Boer

et al. 2009

Circ: Cardiovascular Interventions

120

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Background-Myocardial salvage is often suboptimal after percutaneous coronary intervention in ST-segment elevation myocardial infarction. Posthoc subgroup analysis from a previous trial (AMIHOT I) suggested that intracoronary delivery of supersaturated oxygen (SSO 2 ) may reduce infarct size in patients with large ST-segment elevation myocardial infarction treated early. Methods and Results-A prospective, multicenter trial was performed in which 301 patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset were randomized to a 90-minute intracoronary SSO 2 infusion in the left anterior descending artery infarct territory (nϭ222) or control (nϭ79). The primary efficacy measure was infarct size in the intention-to-treat population (powered for superiority), and the primary safety measure was composite major adverse cardiovascular events at 30 days in the intention-to-treat and per-protocol populations (powered for noninferiority), with Bayesian hierarchical modeling used to allow partial pooling of evidence from AMIHOT I. Among 281 randomized patients with tc-99m-sestamibi single-photon emission computed tomography data in AMIHOT II, median (interquartile range) infarct size was 26.5% (8.5%, 44%) with control compared with 20% (6%, 37%) after SSO 2 . The pooled adjusted infarct size was 25% (7%, 42%) with control compared with 18.5% (3.5%, 34.5%) after SSO 2 (P Wilcoxon ϭ0.02; Bayesian posterior probability of superiority, 96.9%). The Bayesian pooled 30-day mean (ϮSE) rates of major adverse cardiovascular events were 5.0Ϯ1.4% for control and 5.9Ϯ1.4% for SSO 2 by intention-to-treat, and 5.1Ϯ1.5% for control and 4.7Ϯ1.5% for SSO 2 by per-protocol analysis (posterior probability of noninferiority, 99.5% and 99.9%, respectively). Conclusions-Among patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset, infusion of SSO 2 into the left anterior descending artery infarct territory results in a significant reduction in infarct size with noninferior rates of major adverse cardiovascular events at 30 days. Clinical Trial Registration-clinicaltrials.gov Identifier: NCT00175058 (Circ Cardiovasc Intervent. 2009;2:366-375.)

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Section: Discussionmentioning

confidence: 68%

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Stone

Martin

Boer

et al. 2009

Circ: Cardiovascular Interventions

120

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“…5 Whole heart studies from cardiac transplantation indicate that 99m Tc sestamibi and 201 Tl can accurately quantitate the extent of myocardial scarring. 6,7 Similarly, in biopsy specimens from humans, a linear relation was found between redistribution 201 Tl and reinjection 201 Tl uptake and percentage fibrosis, 8 rest 99m Tc sestamibi, 9,10 and NH3/fluorodeoxyglucose. 11,12 They also noted that tracer activity provides information about improved postoperative function.…”

Section: Discussionmentioning

confidence: 81%

Residual Cardiomyocytes and Scintigraphic Findings in Advanced Coronary Artery Disease

Fujino

Matsunari²,

Saga³

et al. 1999

Jpn Circ J

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echnetium-99m-tetrofosmin ( 99m Tc-tetrofosmin) is a cationic lipophilic myocardial perfusion tracer that has recently become available for clinical use. We previously demonstrated that 99m Tc-tetrofosmin imaging can provide information on myocardial viability comparable to thallium-201 ( 201 Tl) imaging in patients with coronary artery disease (CAD) and left ventricular dysfunction. 1,2 However, this has not yet been confirmed by histological examination. We report our assessment of the relationship between scintigraphic and histological findings in a patient with advanced CAD, from whom the entire left ventricular myocardium was available at autopsy. Case Report Clinical InformationA 68-year-old man suffering from chronic heart failure due to CAD was admitted to hospital with a history of previous myocardial infarction. A resting electrocardiogram revealed abnormal Q waves in leads V1-V4. Chest roentgenogram showed marked cardiomegaly with 67% of the cardiothoracic ratio; there was no lung congestion.Cardiac catheterization confirmed total occlusion of the left anterior descending artery, 90% stenosis in the luminal diameter of the left circumflex artery and 90% stenosis of the right coronary artery ( Fig 1A). Radionuclide ventriculography demonstrated dyskinesis in the apical wall, akinesis in the anteroseptal wall, and hypokinesis in the lateral wall. The left ventricular ejection fraction was 30% ( Fig 1B). The patient underwent rest 99m Tc-tetrofosmin and exercise-redistribution-reinjection 201 Tl imaging. He died from drowning in the bath 4 weeks after the scintigraphic study. There was no cardiac event after the radionuclide study. Single-Photon Emission Computed Tomographic (SPECT) ImagingExercise stress 201 Tl imaging was performed using a supine bicycle ergometer. Exercise was started with a workload of 25 W and increased by 25 W intervals for every 2 min of stress. Exercise was terminated at 75 W when fatigue occurred. One minute before cessation of exercise, 74 MBq of 201 Tl was injected and an exercise image was obtained. A redistribution image was obtained 3 h after the first injection; an additional 55 MBq of 201 Tl were injected at rest, and 201 Tl reinjection imaging was started within 10 min of the second injection.Myocardial SPECT imaging was performed using a 3-headed SPECT system with low-energy, high-resolution parallel-hole collimators (GCA9300A/HG, Toshiba, Tokyo, Japan). The detector system was interfaced to a dedicated nuclear medicine computer (GMS5500A, Toshiba). A total of 60 projection images were obtained Jpn Circ J 1999; 63: 64 -67 (Received April 23, 1998; revised manuscript received September 8, 1998; accepted September 24, 1998 A 68-year-old man suffering from chronic heart failure due to coronary artery disease (CAD) underwent rest technetium-99m ( 99m Tc)-tetrofosmin and thallium-201 ( 201 Tl) with reinjection studies, but died thereafter. The heart was removed and sectioned into short-axis slices and examined by gross and microscopic pathologic methods. A close correlatio...

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“…Close correlation between myocardial infarct size measured by SPECT myocardial perfusion imaging and the actual extent of fibrosis in human hearts has been demonstrated in anatomic-pathologic studies [18,19]. Medrano et al [18] investigated 15 consecutive patients who were submitted to orthotopic cardiac transplantation due to ischemic cardiomyopathy with prior myocardial infarction.…”

Section: Assessment Of Myocardial Salvage and Infarct Sizementioning

confidence: 99%

Nuclear Cardiology Core Laboratory: State of the Art

Simões¹,

Neverve²,

Schwaiger³

et al. 2003

Heart Drug

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Considering the low mortality rate related to cardiovascular diseases achieved by the currently available therapeutic options, proving the superiority of a new drug/intervention over standard treatment using mortality as the end point requires the inclusion of several thousands of patients in a prospective randomized clinical trial. The high costs involved in such trials represent a severe limitation for the development of new therapeutic strategies. At the same time, however, there is increasing acceptance that cardiac functional parameters, changes in which are directly related to the beneficial effect of an intervention, can be used as surrogate end points in small-sample size pilot-phase studies. This study design has been shown to be advantageous not only regarding cost-saving aspects but also for providing objective evaluation of the beneficial effect of a new treatment. In addition, the design helps in establishing the number of patients to be included in the definitive trial as well as determining the best dosage to be used. This review describes the available information supporting the use of nuclear cardiology imaging to reliably assess multiple cardiac function parameters constituting adequate surrogate end points for the assessment of therapeutic effects in several cardiovascular diseases. In addition, the technical aspects, feasibility and clear advantages of the use of nuclear cardiology core laboratories for centralized imaging processing/analysis in the context of multicenter clinical trials are also presented.

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Assessment of Myocardial Viability With ^99m Tc Sestamibi in Patients Undergoing Cardiac Transplantation

Abstract: 99mTc sestamibi scintigraphy can be used to accurately quantify the extent of myocardial scarring. Furthermore, the relative sestamibi activity in perfusion defects, measured several hours after administration, is a good indicator of myocardial viability determined with microscopy.

Cited by 115 publications

References 44 publications

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Residual Cardiomyocytes and Scintigraphic Findings in Advanced Coronary Artery Disease

Nuclear Cardiology Core Laboratory: State of the Art

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Assessment of Myocardial Viability With 99m Tc Sestamibi in Patients Undergoing Cardiac Transplantation

Abstract: 99mTc sestamibi scintigraphy can be used to accurately quantify the extent of myocardial scarring. Furthermore, the relative sestamibi activity in perfusion defects, measured several hours after administration, is a good indicator of myocardial viability determined with microscopy.

Cited by 115 publications

References 44 publications

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction

Residual Cardiomyocytes and Scintigraphic Findings in Advanced Coronary Artery Disease

Nuclear Cardiology Core Laboratory: State of the Art

Contact Info

Product

Resources

About

Assessment of Myocardial Viability With ^99m Tc Sestamibi in Patients Undergoing Cardiac Transplantation