Preoperative identification of viable myocardium: effectiveness of nitroglycerine-induced changes in myocardial Sestamibi uptake.
In order to predict tissue viability in infarcted myocardial areas, changes induced by nitroglycerine infusion on Sestamibi myocardial uptake were evaluated in 37 patients with previously confirmed myocardial infarction undergoing coronary artery bypass grafting, and compared with echocardiographic and perfusional changes occurring after the operation. The improvement of Sestamibi uptake after nitroglycerine correctly classified 24/26 (92%) patients showing postoperative improvement of wall motion in the infarcted area, whereas 24/31 (77%) patients with nitroglycerine-induced increase in Sestamibi uptake had improved wall motion after operation. The presence of collateral flow to the infarcted area was associated with a significantly (P < 0.01) higher increase in Sestamibi uptake both during nitroglycerine infusion and postoperatively. An increase in wall motion score after operation was associated with a significantly higher (P < 0.05) increase in Sestamibi uptake score during nitroglycerine infusion. Thus, the results of this study suggest that Sestamibi perfusional myocardial scintigraphy during nitroglycerine infusion is capable of assessing viable but chronically hypoperfused myocardium and predicting postoperative wall motion and perfusional improvement, to yield the best results in patients with evidence of collateral circulation that supplies the infarcted area.
Greco
C
C
Institute of Cardiac Surgery, Department of Experimental Medicine, University La Sapienza, Rome, Italy.
Ciavolella
M
M
Tanzilli
G
G
Sinatra
R
R
Macrina
F
F
Schillaci
O
O
Tavolaro
R
R
Scopinaro
F
F
Campa
P P
PP
Marino
B
B
D000368:Aged; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects; D004452:Echocardiography; D006321:Heart / Q000000981:diagnostic imaging* / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D005996:Nitroglycerin / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014665:Vasodilator Agents / Q000008:administration & dosage*
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D005996:Nitroglycerin