title: Comparison of sestamibi, thallium, echocardiography and PET for the detection of hibernating myocardium.
abstract: The detection of hibernating myocardium is important because revascularisation results in improved function and prognosis in patients with hibernation but not in those with non-viable myocardium. The primary aim of this study was to compare the diagnostic accuracy of four techniques with respect to hibernation in the same study population with 6-12 months of follow-up. Twenty-five males underwent rest-stress sestamibi and delayed (>18 h) thallium scintigraphy, high-dose dobutamine stress echocardiography and nitrogen-13 ammonia/fluorine-18 fluorodeoxyglucose (NH(3)/FDG) positron emission tomography (PET). The pre-operative ejection fraction was 36.2% (+/-7.3%). Follow-up was 8.1 (+/-2.8) months. Using postoperative improvement in wall motion on echocardiography as the gold standard, 6/34 dysfunctional vascular territories were hibernating. The mean uptake of all tracers was significantly higher in hibernating than in non-viable territories ( P<0.05). Normal perfusion or mismatch on PET (FDG>NH(3) uptake) and the pattern of response to dobutamine on echocardiography were also predictive of recovery ( P<0.001 and P=0.02 respectively). Univariate logistic regression identified sestamibi, ammonia and FDG as independent predictors of hibernation. FDG-PET was, however, the only independent predictor using multivariate analysis. The nuclear techniques had high negative predictive values (NPV) of >or=95% but lower positive predictive values (PPV) of 45%-75% as compared with echocardiography, which had an NPV of 87% and a PPV of 100%. PET was the most powerful predictor of hibernation although the combination of a technique with a high PPV (echocardiography) and a high NPV (PET or sestamibi) may represent the optimal clinical choice.
authors.affiliation: Clinical PET Centre, Guys and St Thomas's Hospitals, London, UK. sally.barrington@kcl.ac.uk
authors.forename: S F
authors.initials: SF
authors.lastname: Barrington
authors.forename: J
authors.initials: J
authors.lastname: Chambers
authors.forename: W A
authors.initials: WA
authors.lastname: Hallett
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Doherty
authors.forename: J C
authors.initials: JC
authors.lastname: Roxburgh
authors.forename: T O
authors.initials: TO
authors.lastname: Nunan
mesh_terms: D000328:Adult; D000368:Aged; D000641:Ammonia; D002247:Carbon Isotopes; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000175:diagnosis / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002247:Carbon Isotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C027549:thallium chloride; D000641:Ammonia; D017256:Technetium Tc 99m Sestamibi; D013793:Thallium