Placebo or trimetazidine (99m)Tc tetrofosmin myocardial SPECT and low-dose dobutamine echocardiography in hibernating myocardium.
BACKGROUND
Trimetazidine (TMZ) improves (99m)Tc sestamibi uptake in myocardial single photon emission tomography (SPECT). This study compared TMZ (99m)Tc tetrofosmin SPECT and low-dose dobutamine echocardiography (LDDE) as predictors of functional recovery of hibernating myocardium after coronary revascularization.


METHODS
Thirty-one patients with prior myocardial infarction and left ventricular dysfunction underwent coronary angiography, LDDE, placebo SPECT and TMZ SPECT. Echocardiographic follow-up was obtained at 2/6 months; the clinical follow-up lasted 2 years.


RESULTS
Twenty-three (74.2%) patients (195 dysfunctioning left ventricular segments) were revascularized. TMZ improved (99m)Tc tetrofosmin uptake (p = 0.0001) as well as LVEF at gated SPECT (p = 0.04). At 2-months, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated (LDDE 71.9, 78.7, 71, 79.5; placebo SPECT 66.2, 75.6, 65.4, 76.3; TMZ SPECT 79.2, 67.7, 61.6, 83.3, respectively). The specificity improved in placebo and TMZ SPECT (82.1 and 78.7%) at 6-months follow-up. Two patients (2/23) with hibernating myocardium treated with revascularization and three (3/4) treated medically died a cardiac death (p = 0.0016, log rank 12.89). None (0/4) without viability died during the 2-year follow-up (p = 0.6, log rank 0.28).


CONCLUSIONS
The addition of TMZ to (99m)Tc tetrofosmin SPECT improved diagnostic accuracy. The importance of hibernating myocardium revascularization was confirmed.
Feola
Mauro
M
Department of Cardiovascular Diseases, Nuclear Medicine Service, Ospedale Santa Croce e Carle Cuneo, Cuneo, Italy. m_feola@virgilio.it
Biggi
Alberto
A
Francini
Antonella
A
Leonardi
Giovanni
G
Vado
Antonello
A
Ribichini
Flavio
F
Uslenghi
Eugenio
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014292:Trimetazidine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology
D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi; D014292:Trimetazidine