Value of rest thallium-201/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability

Marzullo, Paolo; Parodi, Oberdan; Reisenhofer, Barbara; Sambuceti, Gianmario; Picaño, Eugenio; Distante, Alessandro; Gimelli, Alessia; LʼAbbate, Antonio

doi:10.1016/0002-9149(93)90733-s

Cited by 214 publications

(39 citation statements)

References 24 publications

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“…[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] The lower specificity of nuclear imaging can again be an issue of duration of follow-up. Recent data have demonstrated that a substantial percentage of segments need longer time after revascularisation to (fully) recover in function.…”

Section: Figmentioning

confidence: 99%

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Schinkel

Bax

Geleijnse

et al. 2003

European Heart Journal

158

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Section: Figmentioning

confidence: 99%

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Schinkel

Bax

Geleijnse

et al. 2003

European Heart Journal

158

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“…[1][2][3][4][5][6][7][8] However, there were wide ranges of sensitivity, specificity, and accuracy (74-91%, 73-95%, and 73-91%, respectively) for prediction of reversible dysfunction, possibly because most studies included patients with various degrees of regional and global left ventricular (LV) function. In addition, more precise equipment may be required in order to obtain a satisfactory level of the accuracy with DSE.…”

mentioning

confidence: 99%

Resting Ultrasonic Tissue Characterization and Dobutamine Stress Echocardiography for Prediction of Functional Recovery in Chronic Left Ventricular Ischemic Dysfunction.

et al. 2001

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revious studies have shown the usefulness of lowdose dobutamine stress echocardiography (DSE) for the assessment of viable myocardium and the prediction of functional recovery after revascularization in patients with chronic coronary disease. [1][2][3][4][5][6][7][8] However, there were wide ranges of sensitivity, specificity, and accuracy (74-91%, 73-95%, and 73-91%, respectively) for prediction of reversible dysfunction, possibly because most studies included patients with various degrees of regional and global left ventricular (LV) function. In addition, more precise equipment may be required in order to obtain a satisfactory level of the accuracy with DSE.Recently, a cardiac cycle-dependent variation of ultrasonic integrated backscatter (IBS-CV), which reflects intramural contractile performance and myocardial thickening, [9][10][11][12] has been anticipated as useful for assessing myocardial viability and predicting LV functional recovery in patients with reperfused acute myocardial infarction. 13 In the setting of acute myocardial infarction, the characteristic of salvageable myocardium was reversibility of the blunted amplitude of IBS-CV. Pasquet et al reported that resting IBS-CV closely paralleled contractile reserve in patients with chronic LV ischemic dysfunction, 14 but further study is required to elucidate several aspects of the usefulness of IBS. We have Japanese Circulation Journal Vol. 65, May 2001 gradually increased the number of opportunities for evaluating the pertinence of revascularization in patients with chronic LV ischemic dysfunction, and so we designed this study to determine the sensitivity, specificity, and accuracy of resting % systolic wall thickening (resting WT), resting IBS-CV, DSE, and low-dose dobutamine stress IBS-CV (DSE-IB) in predicting functional recovery in patients with chronic LV ischemic dysfunction, and we also evaluated the effect of global LV function on the accuracy of this study. Methods Study PopulationWe studied 48 patients with a previous (mean 9±5 months after the onset) myocardial infarction between June and December, 1998. For inclusion in the study, the following criteria needed to be fulfilled.1. Previous myocardial infarction including at least one akinetic segment as demonstrated by transthoracic echocardiography.2. A suitable acoustic window to allow DSE with IBS. 3. Clinical evidence of myocardial ischemia, and scheduling for percutaneous transluminal coronary angioplasty (PTCA).4. No cardiac event during the follow-up period after revascularization.All patients underwent combined low-and high-dose DSE with IBS and radionuclide ventriculography (RNV) before PTCA. For a mean of 10 months (range, 5-24 months) after PTCA, transthoracic echocardiography at rest and the IBS study were repeated. All patients gave This study was designed to assess the diagnostic accuracy of the percentage of resting systolic wall thickening (WT), dobutamine stress echocardiography (DSE), resting cyclic variation of integrated backscatter (IBS-CV), and low-dose dobutamine...

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“…No gold standard for myocardial viability was used such as fluorine-18 fluorodeoxyglucose positron emission tomography, 201 Tl stress-redistribution-reinjection [27], 201 Tl rest-redistribution or low-dose dobutamine echocardiography [28]. Furthermore, we have no data on outcome following revascularization.…”

Section: Study Limitationsmentioning

confidence: 99%

Detection of residual wall motion after myocardial infarction by gated technetium-99m tetrofosmin SPET: a comparison with contrast ventriculography

et al. 2001

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The differentiation of residual viability from necrotic myocardium in patients with a prior myocardial infarction is important when deciding whether revascularization is indicated. Myocardial viability can be assessed by studying perfusion and regional wall motion. Gated single-photon emission tomography (SPET) imaging allows the simultaneous assessment of perfusion and function through a single study. The aim of this study was to analyse the concordance between wall motion score derived by gated SPET and by contrast ventriculography. Furthermore, the agreement between myocardial perfusion and regional myocardial wall motion was analysed for both techniques. We studied a homogeneous group of 26 consecutive patients with a prior myocardial infarction, using both gated technetium-99m tetrofosmin SPET and contrast ventriculography. A seven-segment model of the left ventricle was employed to score regional myocardial wall motion on images obtained with gated SPET and contrast ventriculography using a four-point scale. Contrast ventriculography was performed within 2 weeks of the gated SPET study. Prevalence of abnormal wall motion (akinetic or dyskinetic) was 24/182 (13%) for gated SPET and 25/182 (14%) for contrast ventriculography (P = NS). There was a high agreement (80%) in wall motion score between gated SPET and contrast ventriculography (kappa = 0.67, P < 0.001). The agreement was better in segments with normal or mild to moderate hypoperfusion (82%, kappa = 0.69) than in those with severe hypoperfusion (67%, kappa = 0.56). The agreement between myocardial perfusion and myocardial wall motion was 89% (162/182), kappa = 0.57, for gated SPET and 80% (145/182), kappa = 0.21, for contrast ventriculography. The relation between the summed wall motion scores per patient on gated SPET and contrast ventriculography was excellent (y = 0.81x + 2.9, r = 0.82, P < 0.01). Thirteen (43%) out of 30 segments with severely diminished or no myocardial perfusion showed normal or hypokinetic wall motion on gated SPET, suggesting residual myocardial viability in malperfused regions. Our results suggest that gated SPET imaging is a reliable tool for the assessment of regional wall motion in post-myocardial infarction patients. Furthermore, in patients with a previous myocardial infarction, gated SPET imaging has the potential to detect preserved wall motion in regions with fixed perfusion defects, which might be indicative of residual myocardial viability.

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Value of rest thallium-201/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability

Cited by 214 publications

References 24 publications

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Resting Ultrasonic Tissue Characterization and Dobutamine Stress Echocardiography for Prediction of Functional Recovery in Chronic Left Ventricular Ischemic Dysfunction.

Detection of residual wall motion after myocardial infarction by gated technetium-99m tetrofosmin SPET: a comparison with contrast ventriculography

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