Selective intracoronary injection of sestamibi to detect myocardial viability: Perdiction of perfusion and contractile recovery after percutaneous transluminal coronary angioplasty

Carlo Trani, Alessandro Giordano, Antonella Lombardo, Alessandro Lupi, Mario Attilio Mazzari, Giovanni Schiavoni

Risultato della ricerca: Contributo in rivistaArticolo in rivista

2 Citazioni (Scopus)

Abstract

Background. The main limitation of myocardial single photon emission computed tomography (SPECT) in detecting hibernating myocardium is the poor delivery of radiotracers in hypoperfused areas supplied by severely stenotic coronary arteries. Increasing local availability of radiotracers by intracoronary injection might represent an attractive solution. The hypothesis that the intracoronary administration of sestamibi could improve myocardial SPECT accuracy in detecting hibernating myocardium was addressed in this pilot study. Methods and Results. Seven patients with prior myocardial infarction and severe stenosis of the infarct-related artery underwent myocardial SPECT after intracoronary injection of technetium 99m sestamibi immediately before percutaneous transluminal coronary angioplasty (PTCA). Wall motion and perfusion were evaluated, before and 1 month after PTCA, by 2-dimensional echocardiography and rest-redistribution thallium 201 SPECT. A "low-flow area" was identified on the pre-PTCA Tl-201 SPECT image as the area with less than 50% of maximum radiotracer uptake. Changes in wall motion and perfusion in the low-flow area were compared with results of intracoronary sestamibi imaging. On a pixel-by-pixel analysis, intracoronary sestamibi predicted perfusion recovery within the low-flow area with a 91% sensitivity, a 78% specificity, and an 82% overall accuracy. Only in the 5 patients with an extent of sestamibi uptake greater than one third of the low-flow area was an improved regional and global left ventricular wall motion observed after PTCA (wall motion score index decreased from 1.95 ± 0.28 to 1.60 ± 0.34, P = .007; left ventricular ejection fraction increased from 42% ± 7% to 49% ± 7%, P = .001; asynergic segments in the low-flow area decreased from 3.6 ± 0.9 to 1.8 ± 1.5, P = .021). Conclusions. In patients with prior myocardial infarction and severe stenosis of the infarct-related artery, sestamibi uptake after intracoronary administration identified viable myocardium that was undetected after rest-redistribution thallium SPECT but capable of clinically significant contractile improvement after revascularization.
Lingua originaleEnglish
pagine (da-a)473-481
Numero di pagine9
RivistaJournal of Nuclear Cardiology
Volume10
DOI
Stato di pubblicazionePubblicato - 2003

Keywords

  • Myocardial viability
  • Percutaneous transluminal coronary angiosplasty
  • Revascularization
  • Single photon emission computed tomography

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