title: Detecting viable hibernating myocardium in chronic coronary artery disease--a comparison of resting 201Tl single photon emission computed tomography (SPECT), 99mTc-methoxy-isobutyl isonitrile SPECT after nitrate administration, and 201Tl SPECT after 201Tl-glucose-insulin infusion.
abstract: To identify and quantify the amount of viable hibernating myocardium in patients with chronic coronary artery disease, resting 201Tl single photon emission computed tomography (SPECT) was compared with 99mTc-methoxy-isobutyl isonitrile (MIBI) SPECT after nitrate infusion (nitrate-99mTc-MIBI) and 201Tl SPECT after 201Tl with glucose-insulin-potassium infusion (201Tl-GIK) in 25 patients. Twenty-one patients also underwent completely left ventriculography beforehand and 5+/-4 months afterwards. SPECT images were divided into 9 segments and scored visually from 0 (normal uptake) to 3 (absent). The defect score was calculated as the summation of the total scores (TDS) in each patient. The TDS of nitrate-99mTc-MIBI images (6.3+/-4.3) and 201Tl-GIK images (5.8+/-4.2) were significantly lower than the 7.4+/-4.3 of resting 201Tl images (p<0.01). Based on the improvement of wall motion after coronary revascularization, the sensitivity of 201Tl-GIK imaging (85%) was significantly higher (p<0.05), and that of nitrate-99mTc-MIBI imaging (79%) also tended to be higher (p=0.08), than that of 201Tl imaging (62%) in detecting viable myocardium. The specificity of the 3 methods was almost the same. The nitrate-99mTc-MIBI and 201Tl-GIK methods were more useful than the resting 201Tl method for evaluating viable hibernating myocardium. Furthermore, the 201Tl-GIK method may provide a more accurate estimate of the amount of viable myocardium than the nitrate-99mTc-MIBI method.
authors.affiliation: Gunma Prefectural Cardiovascular Center, Maebashi, Japan. toyama@ca.mbn.or.jp
authors.forename: T
authors.initials: T
authors.lastname: Toyama
authors.forename: H
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: N
authors.initials: N
authors.lastname: Isobe
authors.forename: H
authors.initials: H
authors.lastname: Adachi
authors.forename: S
authors.initials: S
authors.lastname: Naito
authors.forename: S
authors.initials: S
authors.lastname: Oshima
authors.forename: K
authors.initials: K
authors.lastname: Taniguchi
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000473:pathology*; D009566:Nitrates / Q000008:administration & dosage / Q000494:pharmacology; D011188:Potassium / Q000008:administration & dosage / Q000494:pharmacology; D012680:Sensitivity and Specificity; D013667:Technetium; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000592:standards
chemical_list: D007328:Insulin; D009566:Nitrates; D013794:Thallium Radioisotopes; C030396:glucose-insulin-potassium cardioplegic solution; D013667:Technetium; D017256:Technetium Tc 99m Sestamibi; D005947:Glucose; D011188:Potassium