Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi.

Abstract

In patients with coronary artery disease and left ventricular dysfunction, quantified sestamibi activity 1 hour after rest injection parallels redistribution 201Tl activity after a resting injection, suggesting that uptake and subsequent handling of sestamibi are more complex than can be explained by a pure flow tracer with no redistribution. Quantitative analysis of regional activities of both 201Tl and sestamibi after resting injections can differentiate viable from nonviable myocardium, and the two agents comparably predict reversibility of significant regional wall motion abnormalities after revascularization in such patients to a similar degree.

Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan

“…The predictive values of AUC, sensitivity and specificity were comparable or slightly lower than the precedent investigations [5,8,12]. However, ours were comparable with the results by Acampa et al using sublingual nitrate administration [9].…”

“…Mean EFs were 34±10% by Udelson et al [8] and 36±9% by Kang et al [12], and those in most studies were from 30% to 50% [5]. In contrast, our study population showed mean EF of 50% and mean EDV of 103 mL before revascularization, average segmental %uptake of 66% and 55% for improved and non-improved groups, and mean visual perfusion defect score of 1 and 1.3 for improved and non-improved groups, respectively.…”

“…Udelson et al found that 201 Tl and 99m Tc-MIBI regional activities were similar in segments with reversible (72 ± 11% versus 75 ± 9%, respectively) as well as irreversible ventricular dysfunction (51 ± 11% versus 50 ± 8%) [8]. The cutoff value to separate reversible from irreversible segments was approximately 60%.…”

“…Assessment of myocardial viability after myocardial infarction has been considered vital for indicating coronary revascularization, and a number of studies have evaluated predictive values of 99m Tc-MIBI for wall motion recovery in the US and European counties [8,12,[22][23][24]. Histological basis was given by Maes et al, who found a linear relation between percent fibrosis and MIBI uptake [10].…”

“…Although FDG may provide better diagnostic ability for detecting potentially reversible myocardial dysfunction, single-photon myocardial perfusion tracers continue to be one of the best convenient choices for clinical practice. Prediction of regional functional recovery was successfully achieved by 99m Tc-hexakis-2-methoxy-isobutyl isonitrile (MIBI) SPECT as well as by 201 Tl, and viable and non-viable segments could be differentiated [7][8][9][10][11][12].…”