Technetium99msestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting

Thomas, Gregory S.; Miyamoto, Michael I.; Morello, Andrea; Majmundar, Haresh; Thomas, Jennifer J.; Sampson, Christine H.; Hachamovitch, Rory; Shaw, Leslee J.

doi:10.1016/j.jacc.2003.07.041

Cited by 108 publications

(8 citation statements)

References 34 publications

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“…Gated perfusion SPECT with 99m Tc-labelled tracer is commonly used for prognosis assessment and clinical decision-making [3]. In addition, cardiac sympathetic innervation can be directly imaged with 123 I-meta-iodobenzylguanidine ( 123 I-mIBG), a radiolabelled norepinephrine analogue [4] that reflects neuronal integrity by visualising reuptake and retention in cardiac sympathetic terminals [5].…”

Section: Introductionmentioning

confidence: 99%

Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium–zinc–telluride (CZT) cameras: a gated cardiac phantom study

et al. 2016

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BackgroundThe impact of increased energy resolution of cadmium–zinc–telluride (CZT) cameras on the assessment of left ventricular function under dual-isotope conditions (99mTc and 123I) remains unknown.The Amsterdam-gated dynamic cardiac phantom (AGATE, Vanderwilt techniques, Boxtel, The Netherlands) was successively filled with a solution of 123I alone, 99mTc alone, and a mixture of 123I and 99mTc. A total of 12 datasets was acquired with each commercially available CZT camera (DNM 530c, GE Healthcare and DSPECT, Biosensors International) using both energy windows (99mTc or 123I) with ejection fraction set to 33, 45, and 60 %. End-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (LVEF), and regional wall motion and thickening (17-segment model) were assessed using Cedars-Sinai QGS Software. Concordance between single- and dual-isotope acquisitions was tested using Lin’s concordance correlation coefficient (CCC) and Bland–Altman plots.ResultsThere was no significant difference between single- or simultaneous dual-isotope acquisition (123I and 99mTc) for EDV, ESV, LVEF, or segmental wall motion and thickening. Myocardial volumes using single- (123I, 99mTc) and dual-isotope (reconstructed using both 123I and 99mTc energy windows) acquisitions were, respectively, the following: EDV (mL) 88 ± 27 vs. 89 ± 27 vs. 92 ± 29 vs. 90 ± 26 for DNM 530c (p = NS) and 82 ± 20 vs. 83 ± 22 vs. 79 ± 19 vs. 77 ± 20 for DSPECT (p = NS); ESV (mL) 40 ± 1 vs. 41 ± 2 vs. 41 ± 2 vs. 42 ± 1 for DNM 530c (p = NS) and 37 ± 5 vs. 37 ± 1 vs. 35 ± 3 vs. 34 ± 2 for DSPECT (p = NS); LVEF (%) 52 ± 14 vs. 51 ± 13 vs. 53 ± 13 vs. 51 ± 13 for DNM 530c (p = NS) and 52 ± 16 vs. 54 ± 13 vs. 54 ± 14 vs. 54 ± 13 for DSPECT (p = NS); regional motion (mm) 6.72 ± 2.82 vs. 6.58 ± 2.52 vs. 6.86 ± 2.99 vs. 6.59 ± 2.76 for DNM 530c (p = NS) and 6.79 ± 3.17 vs. 6.81 ± 2.75 vs. 6.71 ± 2.50 vs. 6.62 ± 2.74 for DSPECT (p = NS). The type of camera significantly impacted only on ESV (p < 0.001).ConclusionsThe new CZT cameras yielded similar results for the assessment of LVEF and regional motion using different energy windows (123I or 99mTc) and acquisition types (single vs. dual). With simultaneous dual-isotope acquisitions, the presence of 123I did not impact on LVEF assessment within the 99mTc energy window for either CZT camera.

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Section: Introductionmentioning

confidence: 99%

Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium–zinc–telluride (CZT) cameras: a gated cardiac phantom study

et al. 2016

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“…(56) When an MPI is found to be abnormal, the risk for hard events is related to the severity of the abnormality; the greater the affected area, the higher the risk. (51,(57)(58)(59)(60)(61)(62)(63)(64)(65)(66) Hachamovitch et al found that patients with a mildly abnormal scan were at intermediate risk for myocardial infarction (2.7%) but low risk for cardiac death (0.8%). (60) If the patients had to undergo pharmacological testing for any reason, or are elderly, have previous history of CAD, diabetes mellitus or atrial fi brillation, even with a mildly abnormal scan, the risk is increased.…”

Section: Discussionmentioning

confidence: 99%

“…(71) TID is a marker of risk and it has been found to add incrementally over perfusion data. (66,75,76) The approach suggested by R. Hachamovitch and D. Berman (67,71) based on published evidence, is to manage patients with normal scans medically, as revascularization has not been shown to provide potential benefi t in mortality. Patients whose MPIs show reversible perfusion defects extending to <10% of the myocardium (mild to moderate ischemia) should be managed medically including risk factor modifi cation too, as revascularization will not provide a mortality benefi t. If however they are symptomatic and the symptoms impact negatively on their quality of life, or if they have additional markers of severity such as increased pulmonary accumulation of 201Tl or TID, they should be referred for catheterization with a view to intervention.…”

Section: Discussionmentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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Value of nuclear cardiology for the diagnosis and risk stratifi cation of coronary artery disease 106 INTRODUCTIONNuclear cardiology has undergone an outstanding growth during the last 25 years.With technical improvements and new radiopharmaceuticals, higher sensitivity and specifi city of myocardial perfusion imaging (MPI) scans has been achieved for detection and evaluation of ischemic heart disease.MPI is performed with the administration of radiopharmaceuticals which are taken up by the myocardial cells. Different radiotracers can be used, such as: 99m Tc- Sestamibi, 99m Tc-Tetrofosmin, etc.The investigation is performed at rest and stress, providing semiquantitative information on areas of myocardial infarction and ischemia.Beller et al. showed in the "anginal cascade"(1) that, with increasing stress time and myocardial oxygen demand, ischemic ST depression and anginal symptoms appear after fl ow heterogeneity, regional myocardial dysfunction, signifi cant perfusion defects and global left ventricular dysfunction. This accounts for the increased sensitivity, specifi city and accuracy of MPI over symptoms and stress ECG in the diagnosis and follow-up of coronary artery disease.It has developed into one of the most contributory fi elds in clinical decision making for the detection and risk stratifi cation in patients with suspected and known coronary artery disease. USE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE CLINICAL SETTINGMyocardial perfusion SPECT (single photon emission computed tomography) is a widely utilized noninvasive imaging modality for the diagnosis and management of ischemic heart disease. This modality allows a three-dimensional assessment and quantitation of the myocardium and functional assessment through ECG-gating of the perfusion images. Vol. 5, No. 3, 2008 There are several indications for the use of myocardial perfusion SPECT, whether it is for a patient who is not known to have coronary artery disease and the aim is confi rm or rule out the diagnosis, or in the patient with known ischemic heart disease, whether symptomatic or not, for risk-stratifi cation (Table 1). Indications for myocardial perfusion scintigraphy If the patient does not have diagnosis of CADTo exclude or diagnose CAD in patients with suspected CAD As a screening test in those with intermediate or high risk of CAD, e.g. familial hyperlipidemia, type II diabetes mellitus, family history of CAD, and those with atypical symptoms of ischemic heart disease (IHD). In patients with high pretest likelihood for CAD, MPI is mainly useful for risk stratifi cation purposes.In patients with non-diagnostic electrocardiography (ECG), at rest or post-stress. While there are many causes for an abnormal baseline ECG (Table 2), STRESS-ECG is frequently not conclusive. (range 17 to 100).Patients who are at risk of developing peri or postoperative cardiovascular events, i.e. peripheral vascular disease, aortic aneurysm, and the elderly.Acute chest pain -diagnosis of CAD.LBBB can induce perfusion defect in the basal ante...

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“…Perfusion defects are substantial predictors of coronary events in patients with known or suspected coronary heart disease (CHD) 20. It is proposed that concomitant abnormalities of perfusion imaging scans in patients with diabetes with normal coronary angiograms may be caused by micro-angiopathy or endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Mean platelet volume is associated with myocardial perfusion defect in diabetic patients : cardiovascular topic

Sarıkaya

Sahin

Akyol

et al. 2014

CVJA

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SummaryAimOur aim was to evaluate whether there was a relationship between mean platelet volume and myocardial perfusion defect in diabetic patients using myocardial perfusion imaging.MethodForty-four diabetic patients with myocardial perfusion defect (group 1) and 44 diabetic patients without myocardial perfusion defect (group 2), matched for age and gender, were retrospectively examined. Levels of mean platelet volume (MPV) in the two groups were assessed.ResultsMPV was higher in group 1 than group 2 patients (8.76 ± 0.76 and 8.25 ± 0.78 fl), respectively, p = 0.003). Levels of glucose, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, haemoglobin (Hb) and glycosylated haemoglobin (HbA1c), and body mass index (BMI) in the two groups were not statistically significantly different. Multivariate logistic regression analyses showed that MPV was the only variable independently associated with myocardial perfusion defects (OR: 2.401, 95% CI: 1.298–4.440, p = 0.013).ConclusionThis study showed that higher MPV was associated with myocardial perfusion defects. Higher MPV in diabetic patients was independently related to myocardial perfusion defects and may be an indicator of myocardial ischaemia.

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Technetium99msestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting

Abstract: The prognostic value of perfusion imaging is portable and transferable to the outpatient community setting, with multiple components of MPI providing incremental prognostic information.

Cited by 108 publications

References 34 publications

Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium–zinc–telluride (CZT) cameras: a gated cardiac phantom study

Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium–zinc–telluride (CZT) cameras: a gated cardiac phantom study

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Mean platelet volume is associated with myocardial perfusion defect in diabetic patients : cardiovascular topic

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