Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting

Iskandrian, Abdulmassih S.; Kane, Sally A.; Goel, Inder P.; Mundth, Eldred D.; Hakki, A‐Hamid; Segal, Bernard L.

doi:10.1016/0002-9149(83)90304-1

Cited by 178 publications

(27 citation statements)

References 26 publications

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“…[24][25][26][27] No major difference was observed in patient selection between previous studies and ours because the extent of coronary artery disease and the severity of LV dysfunction were similar. The timing of surgery after the viability assessment in patients with hibernating myocardium may influence the magnitude of the recovery in LV function.…”

Section: Discussionmentioning

confidence: 99%

“…27 The time difference between the CABG and the postoperative study is another explanation. Postoperative catheterization was performed 1 week to 6 months after CABG in the previous studies, [24][25][26][27] whereas a repeat study was done at 1-year postoperative in the present study. The greater improvement in LV function observed in our study is due partly to this time difference because recovery in LV function after coronary revascularization is a progressive phenomenon.…”

Section: Discussionmentioning

confidence: 99%

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Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

et al. 1999

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he prognosis of patients with coronary artery disease and severe left ventricular (LV) dysfunction is poor, unless significant functional recovery is gained with coronary revascularization to viable myocardium. [1][2][3][4][5][6][7][8] The purpose of the present study was to evaluate the clinical significance of myocardial viability in the territory supplied by the left anterior descending artery (LAD) in patients with severe LV dysfunction (ejection fraction (EF) ≤35%) who underwent coronary artery bypass grafting (CABG), because the prognostic and procedural significance of CABG to the LAD coronary artery was underscored recently. 9-11 Methods Study PatientsOne hundred consecutive patients, all who demonstrated of having myocardial viability in the LAD territory and who undergone CABG (66 men, 34 women, aged 42-85 years [mean, 66]) were studied retrospectively. Previous myocardial infarction and CABG had occurred in 66 and 3 patients, respectively. Left main coronary artery disease was found in 31 patients, 3-vessel disease in 44, 2-vessel disease in 23, and 1-vessel disease in 2. Written informed consent was obtained from all of the patients. EchocardiographyEchocardiographms were performed using a Toshiba SSH-65A (Tokyo, Japan) or an Aloka SSD-710 (Tokyo, Japan) with 2.5-3.75 MHz transducers. A complete Mmode and 2-dimensional study were performed and recorded on video tape for subsequent analysis. LV segmental wall motion abnormality and systolic wall thickJpn Circ J 1999; 63: 752 -758 (Received May 6, 1999; revised manuscript received June 24, 1999; accepted July 5, 1999 To evaluate the functional recovery after coronary bypass surgery in patients with severe left ventricular (LV) dysfunction (ejection fraction (EF) ≤35%), 100 consecutive patients with viable myocardium in the territory supplied by the left anterior descending artery (LAD) underwent coronary bypass grafting. In addition, cardiac catheterization and single-photon emission computed tomography (SPECT) perfusion imaging with thallium-201 were repeated 1-year postoperatively. Although 12 patients with severe LV dysfunction were preoperatively in a worse New York Heart Association functional class (3.1±0.7 vs 2.4±0.8; p<0.01), had a higher incidence of heart failure (10/12 vs 14/88; p<0.001) and had a worse LVEF (29±5 vs 61±14%; p<0.001) compared with 88 patients without severe LV dysfunction, the operative mortality was similar in the 2 groups (1/12 vs 2/88; p=NS). The postoperative NYHA functional class in the patients with severe LV dysfunction was similar to that in the patients without such dysfunction (1.6±0.7 vs 1.3±0.6; p=NS). In addition, the 1-year postoperative study revealed a significant improvement in the thallium defect score in both the LAD territory (1.7±1.2 to 0.7±1.0, p=0.01) and all the territories (5.2±2.2 to 3.2±1.9, p=0.002) in patients with severe LV dysfunction, whereas no improvement in defect score was found in either of these territories in those without severe LV dysfunction (LAD: 0.6±1.4 to 0.4±1.2, p=NS; All: 1.9±...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

et al. 1999

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“…The presence of 201 Tl after redistribution indicates preserved cellular viability. However, the absence of 201 Tl uptake on the redistribution image is not sufficient to assert no viability [27] . Myocardial uptake of 99m Tc-MIBI is associated with regional perfusion and provides adequate information for the detection of coronary artery disease [33] .…”

Section: Assessment Of Myocardial Viability and Prediction Of Functiomentioning

confidence: 99%

“…J-ACCESS has demonstrated the low risk associated with normal SPECT images [4,8,25] . Many studies have revealed important findings that have demonstrated that stress SPECT images alone have incremental information [25][26][27][28] . Moreover, cardiac function analysis by QGS adds incremental prognostic information [4,25] .…”

Section: Risk Stratification Using Myocardial Perfusion Imagingmentioning

confidence: 99%

Clinical use of nuclear cardiology in the assessment of heart failure

Matsuo

Nakajima²,

Kinuya³

2010

WJC

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A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from nonischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as threedimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123 I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using 123 I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.

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“…[3][4][5][6][7][8][9] Limitations of the Study Data acquisition during dobutamine was performed with one dose of 10 µkg/kg/min. It was impossible to increase the dobutamine dose gradually on-line for wall motion assessment with each dose, as for echocardiography.…”

Section: Prediction Of Improvement In Left Ventricular Ejection Fractionmentioning

confidence: 99%

Additive value of low‐dose dobutamine to technetium‐99m sestamibi‐gated single‐photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft

Zafrir

Arditi

Ben‐Gal

et al. 2003

Clinical Cardiology

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SummaryBackground: The two most useful methods for myocardial viability assessment are perfusion imaging and dobutamine echocardiography.Hypothesis: The present study investigated the additive value of a new method, dobutamine technetium 99m ( 99m Tc)-sestamibi-gated single-photon emission computed tomography (SPECT), which combines these two modalities, to the prediction of wall motion improvement after revascularization.Methods: Fifty-five consecutive patients with ischemic cardiomyopathy, who were referred for viability evaluation, underwent resting and dobutamine (dose, 5-10 µkg/kg/min) gated SPECT with 99m Tc-sestamibi. Of these patients, 36 underwent coronary artery bypass graft (CABG) within 1 month of the study and 32 had repeat resting gated SPECT within 1 year. Global and regional wall motion, wall thickness, and perfusion were simultaneously analyzed at rest and after dobutamine using the 20-segment model; the sestamibi uptake and wall motion response to dobutamine of each segment were rated quantitatively. Based on these findings, the segments were categorized as normal, viable, or nonviable. The predictive values for wall motion improvement were assessed by perfusion, using cutoffs of 50 and 60% of sestamibi uptake, and

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Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting

Cited by 178 publications

References 26 publications

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

Clinical use of nuclear cardiology in the assessment of heart failure

Additive value of low‐dose dobutamine to technetium‐99m sestamibi‐gated single‐photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft

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