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

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)
Publication Information
The Korean Journal of Nuclear Medicine / v.37, no.5, 2003 , pp. 278-287 More about this Journal
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.
Keywords
Quantitative gated myocardial SPECT; nitroglycerin; rest-redistribution Tl-201 SPECT;
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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   DOI   PUBMED   ScienceOn
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   DOI   ScienceOn
3 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   DOI   PUBMED   ScienceOn
4 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   DOI   ScienceOn
5 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   DOI   ScienceOn
6 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   DOI   ScienceOn
7 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   PUBMED
8 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
9 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
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   PUBMED
11 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
12 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   DOI   ScienceOn
13 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   DOI   PUBMED
14 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   PUBMED
15 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   DOI   ScienceOn
16 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   DOI   PUBMED   ScienceOn
17 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
18 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   DOI   ScienceOn
19 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   DOI   ScienceOn
20 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   PUBMED
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   DOI   PUBMED   ScienceOn
22 Abrams J. Hemodynamic effects of nitroglycerin and long-acting nitrates. Am Heart J 1985;110:216-24   PUBMED
23 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   DOI   ScienceOn