Improved detection of myocardial perfusion reversibility by rest-nitroglycerin Tc-99m-MIBI: comparison with Tl-201 reinjection

Batista, Juan F.; Pereztol, O; Valdés, José Alberto Bertot; Sánchez, Elvia; Stüsser, R; Rochela, Luis M.; Lopez, Desiree; Garcia, Ernest

doi:10.1016/s1071-3581(99)90019-3

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…[12324] Nitroglycerine is known to increase blood flow in the hypoperfused myocardium and reduce regional ischemia of the heart muscle in coronary artery disease. [24589] Our study confirms these findings; we found statistically significant improvement of myocardial perfusion after nitroglycerine administration in hypoperfused areas seen at rest myocardial perfusion study. However, previous studies did neither pay much attention nor analyze areas with decreased tracer uptake at MPS with nitroglycerine vis-à-vis rest MPS.…”

Section: Discussionsupporting

confidence: 87%

“…[2][3][4] Numerous studies have demonstrated that 99m Tc Sestamibi myocardial perfusion scintigraphy (MPS) with nitroglycerine has similar results with nitrate-enhanced 201 Tl restredistribution for estimation of myocardial viability, prediction of functional improvements, remodeling, and survival after revascularization in patients with ischemic heart disease. [3][4][5][6] Some authors have concluded that nitroglycerine infusion during 201 Tl imaging is a useful technique for detecting underperfused, viable myocardium, requires less time to perform than rest/ redistribution imaging, and may allow detection of viable myocardium with a single 201 Tl single-photon emission computed tomographic (SPECT) study. They concluded that 201 Tl SPECT with nitrate-augmented redistribution has significant logistical and economic advantages over traditional delayed redistribution with 201 Tl reinjection.…”

Section: Introductionmentioning

confidence: 99%

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Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

et al. 2012

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The objective of this scientific work was to evaluate the extent and severity of perfusion abnormalities on myocardial perfusion scintigraphy (MPS) at rest and with sublingual nitroglycerine, in relation to the presence and anatomical location of collaterals demonstrated by selective coronary angiography (SCA). Twenty-eight patients with unstable angina underwent selective coronary angiography. Eighteen of them were diagnosed with myocardial infarction (MI) 2–15 days prior to examination. Presence or absence of collaterals was noted, with anatomical depiction of donor and recipient arteries as well as evaluation of degree of collateral flow. As an inclusion criterion, collateral flow had to be grade 2 (partial epicardial filling of the occluded artery) or 3 (complete epicardial filling of the occluded artery) in accordance with the Rentrop collateral flow classification. Flow was noted as follows: Complete antegrade (CA), complete retrograde (CR), partial antegrade (PA), and partial retrograde (PR). Myocardial perfusion scintigraphy using Tc-99m Sestamibi at rest and after sublingual administration of nitroglycerine was performed according to a 2-day protocol. Perfusion abnormalities, which were quantified using the 20-segments model and visual 5-point system (0, normal perfusion; 4, absent perfusion), were analyzed according to donor's and recipient's territories, as well as territories with limited or without collateral flow (PA/PR, grade 0–1 flow). A total of 84 arteries were analyzed, with stenosis in 79 of them. Arteries were divided into three groups: Donors (group I), recipients (group II), and arteries with limited or without collaterals (group III). In group I, there were 28 donor arteries, with mean severity of stenosis 71.3 ± 0.65%. In group II, there were 36 recipient arteries and mean severity of stenosis was 94.8 ± 0.26%. In group III, there were 20 arteries, and all of them had either no or poorly developed collaterals (mean severity of stenosis 60.4 ± 2%). In 3 cases, 2 donor arteries gave collaterals to 1 recipient artery, while in 11 cases, a single donor artery gave collaterals to 2 recipient arteries, and in 11 cases there was 1 donor to 1 recipient artery. A total of 1120 MPS segments were analyzed (560 at rest and 560 after nitroglycerine). The number of segments in groups I, II, and III were 204, 242, and 144, respectively. Mean number of segments per donor artery was 7.2 ± 0.7, mean number of segments per recipient artery was 7.0 ± 0.3, and mean number of segments in the territory of arteries without collaterals was 5.5 ± 0.5. In the territory of donor arteries, the mean number of segments with normal, decreased, and absent perfusion at rest was 1.6 ± 0.07, 5.67 ± 0.07, and 0.6 ± 0.03, respectively. After nitroglycerine administration, the mean number of above-mentioned segments was 1.2 ± 0.07, 6.07 ± 0.06, and 2.3 ± 0.06, respectively. There was no significant difference in the mean number of segments with normal and decreased perfusion at rest and after nitroglycerine administration (P =...

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

et al. 2012

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“…Although it has also been reported that MIBI is able to visualise viable tissue, 201 Tl rest-redistribution imaging remains the most widely performed method for the detection of myocardial viability in the daily routine of many centres [1,2]. Since the uptake mechanism of MIBI does not allow significant redistribution in myocardial tissue, approaches aiming to investigate different viability protocols with this tracer have been of a methodological or interventional nature, involving, for example, tracer infusion or nitrate administration [3,4,5,6,7]. Cameron et al demonstrated favourable haemodynamic and metabolic effects of hyperbaric oxygen (HBO) in myocardial infarction [8].…”

Section: Introductionmentioning

confidence: 99%

Effect of O 2 -enriched breathing on myocardial uptake of 99m Tc-sestamibi

Başoğlu

Yapici

Aksakal

et al. 2002

European Journal of Nuclear Medicine and Molecular Imaging

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Oxygen (O(2)) inhalation after acute myocardial ischaemia has long been a part of standard therapy in cardiology. It has also been demonstrated that therapeutic hyperoxia diminishes myocardial stunning. The aim of this pilot study was to investigate whether the uptake kinetics of the myocardial perfusion agent technetium-99m sestamibi (MIBI) during O(2)-enriched breathing is modified in comparison with the kinetics observed under conventional rest imaging performed after injection during inhalation of room air. Nine patients scheduled for coronary intervention (CI) with a documented significant stenosis (> or =50%) of at least one epicardial coronary vessel and one patient with slow flow on coronary angiography were investigated. First, rest MIBI electrocardiogram-gated single-photon emission tomography (G-SPET) with 740 MBq was performed. Two days later, the tracer was injected following a 5-min period of 100% O(2)-supported (nasal catheter) breathing at rest (6 l/min) and a second G-SPET acquisition (O(2)+MIBI G-SPET) was carried out. Patients' medication was not withdrawn and was matched throughout the study. The mean elevation of arterial oxygen saturation achieved was 2.95%. No significant changes in arterial blood pressure or heart rate could be detected at any time during the procedure. Compared with the results of baseline G-SPET, on O(2)+MIBI G-SPET five patients scheduled for CI and the patient with slow flow showed increased tracer uptake in initially ischaemic regions without any alterations in other myocardial regions. In three of these five patients, post-CI imaging could be performed and showed increased tracer uptake in all additional areas detected previously by O(2)+MIBI imaging. In three patients, besides improvement in ischaemic regions, a mild reduction in tracer uptake was observed in myocardium that initially appeared normal. In one of these patients, thallium-201 rest-redistribution SPET was performed and showed an uptake pattern more similar to that seen on O(2)+MIBI images than that on baseline MIBI G-SPET. In one patient, no difference in tracer uptake was observed in pre- and post-CI studies. Improvement was detected in the wall thickening images of the O(2)+MIBI study in seven of the ten patients. Four of these patients showed improvement in the same regions after CI. In this pilot study, it was demonstrated that MIBI injection during O(2)-enriched breathing can be a useful technique for enhancing the detection of viable myocardial tissue. The possible mechanisms of altered tracer kinetics are discussed.

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“…Various nuclear medicine studies have addressed the effect of nitroglycerine on the detection of myocardial perfusion abnormalities. It appears that nitroglycerine may improve the detection of perfusion defects by nuclear medicine stress studies [29]. It remains unclear to what extent nitroglycerine affects the detection of perfusion abnormalities on cardiac CT studies at rest.…”

Section: Discussionmentioning

confidence: 99%

Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99m single-photo emission CT

Cheng

Zeng²,

Arellano³

et al. 2010

BJR

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ABSTRACT. We compared coronary dual-source computed tomography angiography (corDSCTA) with technetium-99m single-photon emission computed tomography (SPECT) for the detection of myocardial perfusion abnormalities. Fifty-five consecutive patients underwent both gated myocardial perfusion SPECT and corDSCTA, the latter during a single arterial-phase injection of contrast agent. The perfusion defects visualised by corDSCTA correlated with the findings of rest/stress SPECT. Abnormal findings on stress SPECT, which were due to either ischaemia or infarct, were found in 24 patients. In comparison to SPECT at rest, corDSCTA detected perfusion defects with a sensitivity and specificity of 100% and 78%, respectively. Compared to SPECT at stress, the sensitivity and specificity values of corDSCTA were 83.3% and 90.3%, respectively. On corDSCTA , the average attenuation values of perfusion defects that corresponded to chronic infarcts (28.5¡22.2 HU) were significantly lower (p50.002) than those of non-infarct-related perfusion defects (43.1¡17.5 HU). Using rest/stress SPECT is the gold standard for the diagnosis of myocardial ischaemia, corDSCTA was able to diagnose ischaemic disease (defined as the presence of high-grade stenotic CAD (>50% luminal narrowing)) with a sensitivity and specificity of 59% and 89%, respectively, in patients with no known history of myocardial infarction (n54). Thus, corDSCTA may serve as a diagnostic tool for the detection of perfusion abnormalities (first) visualised by SPECT. There appears to be a limited correlation between coronary stenotic disease and SPECT findings. Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality in developed countries. During the progression of atherosclerosis, the coronary artery wall undergoes pathological changes with build-up of plaque and subsequent luminal narrowing resulting in impaired blood supply to the myocardium. The focus of perfusion imaging is the detection of pathological changes in myocardial perfusion. At present, various perfusion imaging techniques are in clinical use, including nuclear medicine modalities such as single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiac perfusion MRI.Rest/stress myocardial perfusion SPECT imaging is a non-invasive modality that is widely used to evaluate patients with suspected CAD. Compared with conventional coronary angiography, myocardial perfusion SPECT has demonstrated sensitivities and specificities of 82-98% and 44-91%, respectively, for the detection of CAD [1,2]. SPECT findings such as the extent, severity and reversibility of perfusion defects have shown to be valuable for the prediction of future cardiovascular events [3]. In the absence of morphological correlation, however, SPECT is limited in allocating perfusion defects to their determining coronary lesion, which is a major precondition for accurate therapy planning [4]. As a consequence, invasive conventional coronary angiography (CCA) is often performed in cases of abnorma...

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Improved detection of myocardial perfusion reversibility by rest-nitroglycerin Tc-99m-MIBI: comparison with Tl-201 reinjection

Abstract: 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 TI-201 reinjection protocol.

Cited by 18 publications

References 27 publications

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

Effect of O 2 -enriched breathing on myocardial uptake of 99m Tc-sestamibi

Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99m single-photo emission CT

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