Clinical Value of Acute Rest Technetium-99m Tetrofosmin Tomographic Myocardial Perfusion Imaging in Patients With Acute Chest Pain and Nondiagnostic Electrocardiograms

Heller, Gary V.; Stowers, Stephen A.; Hendel, Robert C.; Herman, Steven D.; Daher, Edouard; Ahlberg, Alan W.; Baron, Jack; Leon, Carlos F. Mendes de; Rizzo, John A.; Wackers, Frans J. Th.

doi:10.1016/s0735-1097(98)00057-6

Cited by 236 publications

(94 citation statements)

References 35 publications

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“…19 -25 However, there is room for improvement. In a cohort of 357 patients imaged acutely as part of an ED triage protocol, Heller et al 24 reported normal images at rest in 12 of 35 patients (34%) who ultimately were diagnosed with ACS, including 2 with acute MI. Normal images were acquired in 7 of 32 patients with ACS (22%) in a cohort of Ͼ1000 patients with chest pain.…”

Section: Discussionmentioning

confidence: 99%

Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging

et al. 2003

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Background-Managing chest pain in the emergency department remains a challenge with current diagnostic strategies.We hypothesized that cardiac MRI could accurately identify patients with possible or probable acute coronary syndrome. Methods and Results-The diagnostic performance of MRI was evaluated in a prospective study of 161 consecutive patients. Enrollment required 30 minutes of chest pain compatible with myocardial ischemia but an ECG not diagnostic of acute myocardial infarction. MRI was performed at rest within 12 hours of presentation and included perfusion, left ventricular function, and gadolinium-enhanced myocardial infarction detection. MRI was interpreted qualitatively but also analyzed quantitatively. The sensitivity and specificity, respectively, for detecting acute coronary syndrome were 84% and 85% by MRI, 80% and 61% by an abnormal ECG, 16% and 95% for strict ECG criteria for ischemia (ST depression or T-wave inversion), 40% and 97% for peak troponin-I, and 48% and 85% for a TIMI risk score Ն3. The MRI was more sensitive than strict ECG criteria for ischemia (PϽ0.001), peak troponin-I (PϽ0.001), and the TIMI risk score (Pϭ0.004), and MRI was more specific than an abnormal ECG (PϽ0.001). Multivariate logistic regression analysis showed MRI was the strongest predictor of acute coronary syndrome and added diagnostic value over clinical parameters (PϽ0.001). Conclusions-Resting

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Section: Discussionmentioning

confidence: 99%

Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging

et al. 2003

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“…Abnormal rest MPI in patients with acute chest pain is highly associated with acute myocardial infarction or the need for subsequent coronary revascularization [2]. These images demonstrate the exquisite sensitivity of MPI to changes in rest myocardial perfusion over a short period.…”

mentioning

confidence: 88%

Rapid assessment of rest myocardial ischaemia in the Chest Pain Unit

Azevedo

Barbirato

Felix

et al. 2009

Eur J Nucl Med Mol Imaging

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A 76-year-old man with a history of coronary bypass graft surgery presented to the Chest Pain Unit with chest discomfort.He underwent myocardial perfusion imaging (MPI) with 99m Tc-sestamibi. Immediately after acquisition of the rest scan he developed a new chest pain episode and received an additional tracer injection. The new images showed hypoperfusion in the inferior and inferolateral walls that were not observed in the previous rest scan images (a arrows). A coronary angiogram revealed subtotal proximal occlusion of a saphenous vein graft to the right coronary artery (b arrow) which was submitted to successful stent implantation.Acute coronary syndrome results from the combination of intermittent thrombotic occlusion and vasoconstriction resulting in markedly decreased regional myocardial perfusion [1]. Abnormal rest MPI in patients with acute chest pain is highly associated with acute myocardial infarction or the need for subsequent coronary revascularization [2]. These images demonstrate the exquisite sensitivity of MPI to changes in rest myocardial perfusion over a short period.

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“…Contemporary studies confirmed the high negative predictive value (99%) of rest MPI for excluding ACS. [10][11][12] However, the radiopharmaceutical must be injected during ongoing chest pain or within 6 hours after chest discomfort has abated, for optimal results. If rest MPI is normal in a patients with acute chest pain, the likelihood of ACS is extremely low and the 30-day outcome is very favorable.…”

Section: Rest Myocardial Perfusion Imaging (Mpi)mentioning

confidence: 99%

“…If rest MPI is normal in a patients with acute chest pain, the likelihood of ACS is extremely low and the 30-day outcome is very favorable. 10 In reality, very few patients evaluated in CPCs still have ongoing chest pain. Rest MPI is therefore rarely performed.…”

Section: Rest Myocardial Perfusion Imaging (Mpi)mentioning

confidence: 99%

Acute chest pain of uncertain etiology, the short and long view

Wackers

2012

Journal of Nuclear Cardiology

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Clinical Value of Acute Rest Technetium-99m Tetrofosmin Tomographic Myocardial Perfusion Imaging in Patients With Acute Chest Pain and Nondiagnostic Electrocardiograms

Cited by 236 publications

References 35 publications

Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging

Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging

Rapid assessment of rest myocardial ischaemia in the Chest Pain Unit

Acute chest pain of uncertain etiology, the short and long view

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