Comparison of Baseline–Nitrate Technetium-99m Sestamibi With Rest–Redistribution Thallium-201 Tomography in Detecting Viable Hibernating Myocardium and Predicting Postrevascularization Recovery

Abstract

Redistribution activity is more important than reversibility when differentiating viable from nonviable territories using rest-redistribution Tl-201. In Tc-99m sestamibi SPECT, nitrate-induced activity changes are particularly useful in identifying myocardial viability. Baseline-nitrate Tc-99m sestamibi SPECT appears no less effective than rest-redistribution Tl-201 in predicting postrevascularization recovery.

Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy

“…9 For the perfusion study, tracer uptake was quantified with the use of an automated program that identified the segment with peak uptake, set its activity to 100%, and scaled the other segments in percent of peak activity. 7 In LDD echocardiography, the identification of reversible dysfunction was based on the presence of contractile reserve in baseline asynergic segments (score, Ն2). On LDD nitrate-enhanced gated sestamibi SPECT, the identification of reversible dysfunction was based on perfusion quantification (sestamibi uptake Ն 50%) in the instance of baseline a-dyskinetic segments (score, 3-4) and on contractile reserve in baseline hypokinetic segments (score, 2).…”

“…6,7 After 1 hour of sestamibi (1111 MBq [30 mCi]) injection, baseline resting gated SPECT was acquired. Immediately thereafter, the dobutamine study was performed.…”

Steps Forward in the Assessment of Myocardial Viability in Left Ventricular Dysfunction

“…Sciagra and coworkers, 28 using a stepwise multivariate discriminative function analysis, demonstrated that quantitative regional activity of 201 Tl using the redistribution images alone (3 to 4 hours after rest injection) provided the most powerful data predicting functional recovery after revascularization compared with rest thallium data or the reversibility between the rest and the redistribution images. Similar findings were also suggested in a study from our laboratory, 24 as well as that of Ragosta and colleagues.…”

“…Studies such as those of Sciagra and colleagues 28 do indeed suggest that traditional thinking regarding the need for multiple image sets in all patients may be obsolete. The present study by Srinivasan and coworkers 12 also suggests that evaluation of metabolic activity by SPECT imaging alone may be sufficient for such purposes in selected circumstances.…”

Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction

“…Various imaging methods are used, such as positron emission tomography (3), myocardial perfusion scintigraphy with thallium-201 (4), and low-dose dobutamine echocardiography (6). After initial concerns, also myocardial perfusion imaging with Tc-99m sestamibi (sestamibi), particularly in combination with nitrate administration, has been demonstrated to give reliable results in the detection of viable hibernating myocardium and in the prediction of postrevascularization recovery (17)(18)(19)(20)(21). However, scanty data are available about the potential prognostic implications of viability detection using sestamibi.…”