title: Classification of ischemic dysfunctional myocardium combining perfusion quantification and contractile reserve evaluation using nitrate-enhanced gated single photon emission computed tomography with dobutamine test.
abstract: OBJECTIVE
  In patients with ischemic cardiomyopathy, the differentiation of dysfunctional myocardium in scarred versus hibernating is oversimplified. We evaluated a more complex classification using an imaging technique currently employed for viability detection, having as reference the postrevascularization outcome of dysfunctional segments.
  
  
  METHODS
  In 35 patients, we performed gated single-photon emission computed tomography (SPECT) (resting and nitrate-enhanced study, the latter with baseline and dobutamine acquisition) before revascularization. The outcome after revascularization was assessed by repeating resting gated SPECT. Dysfunctional segments without functional recovery in postrevascularization gated SPECT were defined scar (either nontransmural or transmural according to tracer activity); those with recovery were divided in stunned (unchanged uptake) or hibernating (improved postrevascularization activity). This reference classification was compared with the categorization based on prerevascularization gated SPECT.
  
  
  RESULTS
  Contractile reserve in dobutamine gated SPECT differentiated scarred from viable segments with 78% accuracy. Tracer activity in nitrate imaging distinguished the degree of transmurality. Nitrate-induced activity increase was significantly higher (p<0.0001) in the hibernating segments (14.9+/-20.4%) than in transmural (4.8+/-13.4%) nontransmural scars (3.3+/-13%), or stunned segments (2.2+/-8%). The presence or absence of nitrate-induced activity increase predicted the postrevascularization perfusion changes in viable myocardium and differentiated hibernating from stunned segments. The prerevascularization classification showed a good agreement with the reference categorization (kappa=0.50). Conclusion. Combining contractile reserve evaluation and perfusion quantification within a single study with baseline-nitrate gated SPECT and dobutamine test it is possible to achieve a comprehensive classification of dysfunctional segments.
authors.affiliation: Unit of Nuclear Medicine, Department of Clinical Physiopatology, University of Florence, Florence, Italy. r.sciagra@dfc.unifi.it
authors.forename: R
authors.initials: R
authors.lastname: Sciagrà
authors.forename: M
authors.initials: M
authors.lastname: Leoncini
authors.forename: A
authors.initials: A
authors.lastname: Mennuti
authors.forename: R P
authors.initials: RP
authors.lastname: Dabizzi
authors.forename: A
authors.initials: A
authors.lastname: Pupi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004280:Dobutamine; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D009204:Myocardial Revascularization; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000503:physiopathology; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi; D007548:Isosorbide Dinitrate