Selective intracoronary injection of sestamibi to detect myocardial viability: Prediction of perfusion and contractile recovery after percutaneous transluminal coronary angioplasty.
BACKGROUND
The main limitation of myocardial single photon emission computed tomography (SPECT) in detecting hibernating myocardium is the poor delivery of radiotracers in hypoperfused areas supplied by severely stenotic coronary arteries. Increasing local availability of radiotracers by intracoronary injection might represent an attractive solution. The hypothesis that the intracoronary administration of sestamibi could improve myocardial SPECT accuracy in detecting hibernating myocardium was addressed in this pilot study.


RESULTS
Seven patients with prior myocardial infarction and severe stenosis of the infarct-related artery underwent myocardial SPECT after intracoronary injection of technetium 99m sestamibi immediately before percutaneous transluminal coronary angioplasty (PTCA). Wall motion and perfusion were evaluated, before and 1 month after PTCA, by 2-dimensional echocardiography and rest-redistribution thallium 201 SPECT. A "low-flow area" was identified on the pre-PTCA Tl-201 SPECT image as the area with less than 50% of maximum radiotracer uptake. Changes in wall motion and perfusion in the low-flow area were compared with results of intracoronary sestamibi imaging. On a pixel-by-pixel analysis, intracoronary sestamibi predicted perfusion recovery within the low-flow area with a 91% sensitivity, a 78% specificity, and an 82% overall accuracy. Only in the 5 patients with an extent of sestamibi uptake greater than one third of the low-flow area was an improved regional and global left ventricular wall motion observed after PTCA (wall motion score index decreased from 1.95 +/- 0.28 to 1.60 +/- 0.34, P =.007; left ventricular ejection fraction increased from 42% +/- 7% to 49% +/- 7%, P =.001; asynergic segments in the low-flow area decreased from 3.6 +/- 0.9 to 1.8 +/- 1.5, P =.021).


CONCLUSIONS
In patients with prior myocardial infarction and severe stenosis of the infarct-related artery, sestamibi uptake after intracoronary administration identified viable myocardium that was undetected after rest-redistribution thallium SPECT but capable of clinically significant contractile improvement after revascularization.
Institute of Cardiology, Universitá Cattolica del Sacro Cuore, Rome, Italy.
Carlo
C
Trani
Alessandro
A
Giordano
Antonella
A
Lombardo
Alessandro
A
Lupi
Francesca
F
Reale
Roberto
R
Patrizi
Giampiero
G
Patrizi
Mario A
MA
Mazzari
Giovanni
G
Schiavoni
Attilio
A
Maseri
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D010865:Pilot Projects; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D020127:Recovery of Function; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage*; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi