title: Methoxyisobutylisonitrile (MIBI) Tc 99m SPECT to establish a correlate to coronary flow reserve, the perfusion reserve, from global and regional myocardial uptake after exercise and rest.
abstract: With 99mTc-MIBI SPECT and a 4 h exercise (E: 150 MBq iv) and rest (R; 800 MBq iv) protocol, global and regional left ventricular (LV) myocardial uptake was determined in 70 patients with angiographically confirmed coronary heart disease (CHD) and in 10 controls. The aim was to establish an E/R ratio as a correlate to coronary vascular reserve, representing perfusion reserve (PR). E/R ratios, obtained from total LV myocardium or from normal or impaired regions, were greater than 1.19 under all conditions, indicating the presence of higher flow during exercise than at rest (even in areas of low flow). Global PR separated (P less than 0.01) controls (1.63 +/- 0.21; mean +/- SD) from severely diseased patients (1.29 +/- 0.14 in 2- or 3-vessel disease) only. Improved differential diagnosis was gained from calibrating the regional E/R ratio to regional differences (E minus R) of uptake. For the left ventricle regional PRs (RPR) for 25 ROIs of the target, framing the myocardium, were determined. RPR at the regional maximum of 99mTc-MIBI uptake was similar in both controls (1.66) and patients (1.63), indicating a high probability of meeting some areas with functionally normal perfusion in patients with CHD. RPR allowed sufficient separation (P less than 0.025) concerning the degree of coronary artery stenosis (RPR in occlusion, 0.26; stenosis greater than 75%, 0.39; less than 75%, 0.56). In controls, the overall value for RPR was 1.14 +/- 0.28 (P less than 0.001). LV global PR and RPR were useful in separating patients with CHD vs controls and in classifying the severity of vascular stenosis.
authors.affiliation: Department of Nuclear Medicine, Technical University of Aachen, Federal Republic of Germany.
authors.forename: U
authors.initials: U
authors.lastname: Buell
authors.forename: H J
authors.initials: HJ
authors.lastname: Kaiser
authors.forename: F
authors.initials: F
authors.lastname: Dupont
authors.forename: R
authors.initials: R
authors.lastname: Uebis
authors.forename: E
authors.initials: E
authors.lastname: Kleinhans
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D000328:Adult; D000368:Aged; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D009570:Nitriles / Q000493:pharmacokinetics; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D005082:Physical Exertion; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009570:Nitriles; D015609:Organotechnetium Compounds; D017256:Technetium Tc 99m Sestamibi