title: Relevance of 99mTc-MIBI rest uptake, ejection fraction and location of contractile abnormality in predicting myocardial recovery after revascularization.
abstract: The aim of this study was to analyse the influence of rest technetium-99m-methoxy-isobutyl-isonitrile (99mTc-MIBI) uptake, left ventricular ejection fraction (EF) and dysfunctional location in the prediction of myocardial viability. Rest 99mTc-MIBI single photon emission computed tomography (SPECT) was analysed in 82 patients (59+/-9 years, 70 men, 12 women) with one or more segments showing severe hypokinesia, akinesia or dyskinesia who had undergone coronary revascularization. Before and within 3-6 months after the revascularization, gated blood pool scintigraphy was performed. In the post-revascularization control, contractile recovery was observed in 48.7% (155/318) of the segments with severe hypokinesia, akinesia or dyskinesia. Significant increases in sensitivity (53%, 72% and 91%, P<0.0001) and negative predictive value (62%, 68% and 79%, P = 0.01) were observed with decreasing rest uptake 99mTc-MIBI levels of 50%, 40% and 30%, respectively. The decrease in specificity was also significant (67%, 53% and 32%, P<0.0001). The negative predictive value was higher than the positive predictive value mainly in patients with EF < or = 0.35 and with anterior dysfunction. In logistic regression analysis, uptake levels and EF were independent variables that influenced sensitivity and specificity. The negative predictive value was influenced by EF and the positive predictive value only by dysfunctional location. This study suggests that the negative predictive value of 99mTc-MIBI SPECT is higher than the positive predictive value, mainly in patients with EF < or = 0.35, and that the rest uptake level, EF and dysfunctional location are factors that must be considered when results of 99mTc-MIBI SPECT are analysed.
authors.affiliation: Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: González
authors.forename: J
authors.initials: J
authors.lastname: Castell-Conesa
authors.forename: J
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: J
authors.initials: J
authors.lastname: Rosselló-Urgell
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013318:Stroke Volume / Q000502:physiology*; D016698:Technetium Tc 99m Pyrophosphate; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
chemical_list: D019275:Radiopharmaceuticals; D016698:Technetium Tc 99m Pyrophosphate; D017256:Technetium Tc 99m Sestamibi