title: 99Tcm-sestamibi tomoscintigraphy at rest and after nitrate administration in predicting wall motion recovery after revascularization.
abstract: To evaluate whether nitroglycerin administered before the injection of sestamibi improves the detection of viable but hypoperfused myocardium, 41 post-infarction patients with left ventricular dysfunction underwent echocardiography and SPET at rest and after nitrate administration. In 25 revascularized patients, perfusion at rest and contractility were assessed 3-4 months after coronary artery bypass grafting. Perfusion (PI) and wall motion indices (WMI) were calculated for each revascularized area. There was a strong correlation between contractility and perfusion defect (r = 0.58, P < 0.0001). Nitrates significantly reduced the number of perfusion defects in hypokinetic (delta PI = 0.25 +/- 0.66) and akinetic (delta PI = 0.32 +/- 0.62), but not in dyskinetic (delta PI = 0.08 +/- 0.62), segments. Twenty-five revascularized patients had 110 asynergic segments and 136 segments with a resting perfusion defect. Function improved in 42% and perfusion in 64% of segments after surgery. Viable segments had a lower PI at rest (2.78 +/- 1.38 vs 3.86 +/- 1.29, P < 0.001) and a lower WMI (2.46 +/- 0.50 vs 2.79 +/- 0.59, P = 0.002). Nitrates reduced the number of perfusion defects slightly more in viable than non-viable segments (delta PI = 0.58 +/- 0.89 vs 0.30 +/- 0.46, P = 0.06). Contractility and perfusion at rest were the most important predictors of functional recovery. The sensitivity and specificity in predicting contractile improvement were 74% and 64% for resting SPET respectively, and 80% and 50% for nitrate SPET respectively. Nitrate administration significantly reduces perfusion defects in asynergic regions; however, its usefulness in predicting contractile recovery may be limited owing to its low specificity. Contractility and sestamibi uptake at rest were the strongest predictors of post-operative wall motion improvement.
authors.affiliation: Institute of Cardiology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Baszko
authors.forename: K
authors.initials: K
authors.lastname: Blaszyk
authors.forename: A
authors.initials: A
authors.lastname: Cieśliński
authors.forename: P
authors.initials: P
authors.lastname: Kwinecki
authors.forename: M
authors.initials: M
authors.lastname: Popiel
authors.forename: M
authors.initials: M
authors.lastname: Jemielity
authors.forename: M
authors.initials: M
authors.lastname: Gembicki
authors.forename: J
authors.initials: J
authors.lastname: Sowiński
mesh_terms: D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005996:Nitroglycerin; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D005996:Nitroglycerin