Simultaneous assessment of function and perfusion during dipyridamole-handgrip Tc-99m sestamibi imaging in chronic coronary artery disease.
The main goal of this work was to know the value of ventricular function in addition to perfusion Tc-99m sestamibi images in the assessment of coronary artery disease (CAD) when using dipyridamole (DIP) associated to isometric exercise. We analyzed 52 patients with suspected CAD; 40 of them had coronary lesions > or = 50% and 12 patients without CAD, conforming study and control groups, respectively. Twenty-eight patients had prior myocardial infarction. A two-day sestamibi protocol was employed with i.v. DIP-handgrip and rest injections, acquiring ECG-gated first pass and planar perfusion images. Sensitivity for perfusion images was 85% and specificity was 91.7%. There was no change between rest and DIP ejection fraction (EF) in controls. CAD patients presented a significant EF decrease with DIP (p: 0.0015). Patients with ischemia in perfusion images had larger EF decrease (p: 0.0001). For the analysis, an EF drop > or = 5% and any wall motion abnormality (WMA) were considered as having an abnormal response to DIP. CAD sensitivity improved significantly to 92.5% when adding EF drop and to 90% when adding WMA parameters, but specificity decreased to 75% with EF drop, and to 58.3% with WMA. In conclusion, first pass parameters from DIP-isometric exercise in addition to perfusion images are not a significant help in the assessment of CAD.
Massardo
T
T
Nuclear Medicine Center, University of Chile Clinical Hospital, Santiago. tmassardo@ns.hospital.uchile.cl
González
P
P
Humeres
P
P
Chamorro
H
H
Ayala
F
F
Yovanovich
J
J
Avendaño
P
P
D000328:Adult; D000368:Aged; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004176:Dipyridamole; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed; D016277:Ventricular Function, Left
D019275:Radiopharmaceuticals; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi