The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Nitroglycerin-Challenged Tc-99m MIBI Quantitative Gated SPECT to Predict Functional Recovery After Coronary Artery Bypass Surgery

니트로글리세린 투여 Tc-99m-MIBI 정량 게이트 심근SPECT를 이용한 관상동맥우회로술 후 심근 기능 회복 예측

  • Lee, Dong-Soo (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kim, Yu-Kyeong (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Cheon, Gi-Jeong (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Paeng, Jin-Chul (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Myoung-Mook (Departments of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Ki-Bong (Departments of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine) ;
  • Chung, June-Key (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Myung-Chul (Departments of Nuclear Medicine, Seoul National University College of Medicine)
  • 이동수 (서울대학교 의과대학 핵의학교실) ;
  • 김유경 (서울대학교 의과대학 핵의학교실) ;
  • 천기정 (서울대학교 의과대학 핵의학교실) ;
  • 팽진철 (서울대학교 의과대학 핵의학교실) ;
  • 이명묵 (서울대학교 의과대학 내과학교실) ;
  • 김기봉 (서울대학교 의과대학 흉부외과학교실) ;
  • 정준기 (서울대학교 의과대학 핵의학교실) ;
  • 이명철 (서울대학교 의과대학 핵의학교실)
  • Published : 2003.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The performance of nitroglycerin-challenged Tc-99m-MIBI quantitative gated SPECT for the detection of viable myocardium was compared with rest/24-hour redistribution Tl-201 SPECT Materials and Methods: In 22 patients with coronary artery disease, rest Tl-20l/ dipyridamole stress Tc-99m-MIBI gated/24-hour redistribution Tl-201 SPECT were peformed, and gated SPECT was repeated on-site after sublingual administration of nitroglycerin (0.6 mg). Follow-up gated SPECT was done 3 months after coronary artery bypass graft surgery. For 20 segments per patient, perfusion at rest and 24-hour redistribution, and wall motion and thickening at baseline and nitroglycerin-challenged state were quantified. Quantitative viability markers were evaluated and compared;(1) rest thallium uptake, (2) thallium uptake on 24-hour redistribution SPECT, (3) systolic wall thickening at baseline, and (4) systolic wall thickening with nitroglycerin-challenge. Results: Among 100 revascularized dysfunctional segments, wall motion improved in 66 segments (66%) on follow-up gated myocardial SPECT after bypass surgery. On receiver operating characteristic (ROC) curve analysis, the sensitivity and specificity of rest and 24-hour delayed redistribution Tl-201 SPECT were 79%, 44% and 82%, 44%, respectively, at the optimal cutoff value of 50% of Tl-201 uptake. The sensitivity and specificity of systolic wall thickening at baseline and nitroglycerin-challenge were 49%, 50% and 64%, 65% at the optimal cutoff value of 15% of systolic wall thickening. Area under the ROC curve of nitroglycerin-challenged systolic wall thickening was significantly larger than that of baseline systolic wall thickening (p=0.004). Conclusion: Nitroglycerin-challenged quantitative gated Tc-99m-MIBI SPECT was a useful method for predicting functional recovery of dysfunctional myocardium.

목적: 생존심근 진단에 있어 니트로글리세린 투여 Tc-99m-MIBI 게이트 심근SPECT의 진단성능을 휴식/지연재분포 Tl-201 심근SPECT와 비교하였다. 대상 및 방법: 22명의 관상동맥질환자에서 Tl-201 휴식/디피리다몰 부하 Tc-99m-MIBI 게이트 지연재분포 Tl-201 심근SPECT를 시행하였다. 이 때 게이트SPECT 시행 후 니트로글리세린 0.6 mg을 설하투여하고 연이어 그 자리에서 게이트SPECT를 1회 더 반복 시행하였다. 환자들에게 관상동맥우회로술을 시행하고 3개월 후 게이트 심근SPECT를 추적검사로 시행하였다. 20 분절 모델을 이용하여 각 분절에서 휴식, 지연재분포, 기저상태와 니트로글리세린투여 후의 심벽운동 및 수축기비후화 등을 정량하였다. 정량화된 생존심근 예측지표들 중, (1) 휴식기 Tl-201 섭취, (2) Tl-201 지연재분포, (3) 기저상태의 수축기비후화, (4) 니트로글리세린 투여 후의 수축 기비후화, 네 가지의 예측성능을 평가하고 비교하였다. 결과: 총 100개의 분절이 분석에 포함되었으며, 이 중 66개(66%)의 분절이 재관류 후 기능 회복을 보였다. 최적 기준점인 50%를 기준으로 하였을 때, ROC 곡선 분석에서 휴식기 Tl-201 섭취와 Tl-201 지연재분포의 민감도, 특이도는 각각 79%와 44%, 그리고 82%와 44%였다. 또한 15%를 기준으로 하여, 기저상태 수축기비후화와 니트로글리세린 투여 후 수축기비후화의 민감도, 특이도는, 각각 49%, 50%와 64%, 65%였다. ROC 곡선의 AUC는 니트로 글리세린 투여 후 수축기비후화가 기저시 수축기비후화에 비하여 유의하게 높았다(p=0.004). 결론: 니트로글리세린 투여 Tc-99m-MIBI 정량적 게이트 심근SPECT는 기능이상 심근에서 기능 회복을 예측하는데 유용한 검사이다.

Keywords

References

  1. Helfant RH, Pine R, Meister SG, Feldman MS, Trout RG, Banka VS. Nitroglycerin to unmask reversible asynergy: correlation with post coronary bypass ventriculography. Circulation 1974;50:108-13 https://doi.org/10.1161/01.CIR.50.1.108
  2. Chesbro JH, Ritman EL, Frye RL, Smith HC, Rutherford BD, Fulton RE, et al. Regional myocardial wall thickening response to nitroglycerin: A predictor of myocardial response to aortocoronary bypass surgery. Circulation 1978;57: 952-7 https://doi.org/10.1161/01.CIR.57.5.952
  3. Bache RJ, Ball RM, Cobb FR, Rembert JC, Greenfield JC Jr. Effects of nitroglycerin on transmural myocardial blood flow in the unanesthetized dog. J Clin Invest 1975;55: 1219-28 https://doi.org/10.1172/JCI108040
  4. Cohn PF, Maddox D, Holman BL, Markis JE, Adams DF, See JR, et al. Effect of sublingually administered nitroglycerin on regional myocardial blood flow in patients with coronary artery disease. Am J Cardiol 1977;39: 672-8 https://doi.org/10.1016/S0002-9149(77)80127-6
  5. Aoki M, Sakai K, Koyanagi S, Takeshita A, Nakamura M. Effect of nitroglycerin on coronary collateral function during exercise evaluated by quantitative analysis of thallium-201 single photon emission computed tomography. Am Heart J 1991;121: 1361-6 https://doi.org/10.1016/0002-8703(91)90139-9
  6. He Z-X, Medrano R, Hays JT, Mahmarian JJ, Verani MS. Nitroglycerin-augmented 201Tl reinjection enhances detection of reversible myocardial hypoperfusion: A randomized, double-blind, parallel, placebo- controlled trial. Circulation 1997;95: 1799-805 https://doi.org/10.1161/01.CIR.95.7.1799
  7. Sciagra R, Bisi B, Santoro GM, Zerauschek F, Sestini S, Pedenovi P, et al. Comparison of baseline-nitrate technetium-99m sestamibi with rest-redistribution thallium-201 tomography in detecting viable hibernating myocardium and predicting postrevascularization recovery. J Am Coll Cardiol 1997;30: 384-91 https://doi.org/10.1016/S0735-1097(97)00192-7
  8. Bax JJ, Wijns W, Cornel JH, Visser FC, Boersma E, Fioretti PM. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol 1997;30: 1451-60 https://doi.org/10.1016/S0735-1097(97)00352-5
  9. Baumgartner H, Porenta G, Lau Y-K, Wutte M, Klaar U, Mehrabi M, et al. Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium- 201 SPECT: Correlation with histopathology in explanted hearts. J Am Coll Cardiol 1998;32:1701-8 https://doi.org/10.1016/S0735-1097(98)00436-7
  10. Bax JJ, Cornel JH, Visser FC, Fioretti PM, van Lingen A, Reijs AE, et al. Prediction of recovery of myocardial dysfunction after revascularization: comparison of fluorine-18 fluorodeoxyglucose/thallium-201 SPECT, thallium-201 stress-reinjection SPECT and dobutamine echocardiography. J Am Coll Cardiol 1996;28: 558-64
  11. Lee DS, Yoon SN, Song HC, Kim K-B, Chung J-K, Lee MM, et al. Predictive values of gated myocardial SPECT for wall motion improvement after bypass surgery. Korean J Nucl Med 1997;31:43-9
  12. Germano G, Erel J, Lewin H, Kavanagh PB, Berman DS. Automatic quantitation of regional myocardial wall motion and thickening from gated technetium-99m-sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1997;30: 1630-7
  13. Paeng JC, Lee DS, Cheon GJ, Kim YK, Chung J-K, Lee MC. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated Tc-99m-MIBI myocardial SPECT. J Nucl Med 2001;42: 695-700
  14. Lee DS, Cheon GJ, Ahn JY, Chung JK, Lee MC. Reproducibility of the assessment of myocardial function using gated Tc-99m-MIBI SPECT and quantitative software. Nucl Med Comm 2000;21:1127-34 https://doi.org/10.1097/00006231-200012000-00006
  15. Lee DS, Cheon GJ, Paeng JC, Kim K-B, Chung JK, Lee MC. Criteria for definition of regional functional improvement on quantitative post-stress gated myocardial SPET after bypass surgery in patients with ischaemic cardiomyopathy. Eur J Nucl Med Mol Imaging 2002;29: 1078-82 https://doi.org/10.1007/s00259-002-0867-5
  16. Pontillo D, Carboni GP, Capezzuto A, Alessi C, Achilli A, Piccini F, et al. Identification of viable myocardium by nitrate echocardiography after myocardial infarction: comparison with planar thallium reinjection scintigraphy. Angiology 1996;47:437-46 https://doi.org/10.1177/000331979604700502
  17. DePuey EG, Ghesani M, Schwartz M, Friedman M, Nichols K, Salensky H. Comparative performance of gated perfusion SPECT wall thickening, delayed thallium uptake, and F-18 fluorodeoxyglucose SPECT in detecting myocardial viability. J Nucl Cardiol 1999;6: 418-28 https://doi.org/10.1016/S1071-3581(99)90008-9
  18. Stollfuss JC, Haas F, Matsunari I, Neverve J, Nekolla S, Ziegler S, et al. $^99m$Tc-tetrofosmin SPECT for prediction of functional recovery defined by MRI in patients with severe left ventricular dysfunction: additional value of gated SPECT. J Nucl Med 1999;40: 1824-31
  19. Gunning MG, Anagnostopoulos C, Davies G, Knight CJ, Pennell DJ, Fox KM, et al. Simultaneous assessment of myocardial viability and function for the detection of hibernating myocardium using ECG-gated 99Tcm-tetrofosmin emission tomography: A comparison with 201Tl emission tomography combined with cine magnetic resonance imaging. Nucl Med Comm 1999;20:209-14
  20. Lee DS, Kang WJ, Cheon GJ, Kim K-B, Chung J-K, Lee MC. Detection of viable myocardium by the change of wall motion or wall thickening using gated Tc-99m-MIBI SPECT after nitroglycerin (abstract). J Nucl Med 1998;39: 59P
  21. La Canna G, Alfieri O, Giubbini R, Gargano M, Ferrari R, Visioli O. Echocardiography during infusion of dobutamine for identification of reversible dysfunction in patients with chronic coronary artery disease. J Am Coll Cardiol 1994;23: 617-26 https://doi.org/10.1016/0735-1097(94)90745-5
  22. Cooke CD, Garcia EV, Cullom SJ, Faber TL, Pettigrew RI. Determining the accuracy of calculating systolic wall thickening using a Fourier transform approximation: a simulation study based on canine and patient data. J Nucl Med 1994;35:1185-92
  23. Abrams J. Hemodynamic effects of nitroglycerin and long-acting nitrates. Am Heart J 1985;110:216-24