title: Detection of hibernated myocardium using intracoronary technetium-99m-sestamibi.
abstract: A possible limitation of intravenously administered perfusion tracers in detecting hibernating myocardium is their poor availability in low-flow areas. We have hypothesized that intracoronary administration might overcome such a limitation. In two patients with a previous anterior myocardial infarction and a severe residual stenosis of the left anterior descending coronary artery, technetium-99m-sestamibi (74 MBq) was selectively injected into the infarct-related coronary artery before successful PTCA. SPECT imaging was carried out 1 hour after the PTCA. In patient 1, evident tracer uptake was detected in the majority of the antero-apical dys-synergic area, previously characterized by a severe irreversible defect (less than 50% of peak activity) at rest-redistribution thallium SPECT ("mismatched pattern"); in patient 2, no uptake of sestamibi was detected in the dys-synergic area showing a severe irreversible defect (less than 50% of peak activity) at rest-redistribution thallium SPECT, ("matched pattern"). Forty days after PTCA, contractile recovery as well as normalization of thallium uptake occurred in patient 1, confirming that most of the dys-synergic area was viable (hibernating), while neither wall motion nor thallium uptake improvement occurred in patient 2, confirming that most of the dys-synergic area was not viable (scar). We conclude that sestamibi retention in the dys-synergic area after selective intracoronary administration correctly identified viable and scarred myocardium. The potential diagnostic value of intracoronary sestamibi at the time of coronary angiography deserves to be validated as a possible alternative to other current procedures for detecting hibernating myocardium.
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Giordano
authors.forename: C
authors.initials: C
authors.lastname: Trani
authors.forename: A
authors.initials: A
authors.lastname: Lombardo
authors.forename: A
authors.initials: A
authors.lastname: Maseri
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003331:Coronary Vessels; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000628:therapy; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi