[Scintigaraphic assessment of viability of the ischemic myocardium while carrying out nitroglycerine-mediated and orthostatic tests].
The work deals with diagnostic possibilities of single photon emission computed tomography (SPECT) of the heart and ECG-synchronized planar scintigraphy (ECG-PS) with 99mTc-tetrophosmine used to determine viability of the ischaemic myocardium in patients presenting with postmyocardium infarction cardiosclerosis. A total of 20 patients diagnosed with Ischaemic heart disease (IHD), functional class III-IV angina of effort, postmyocardium infarction cardiosclerosis were examined. All the patients underwent SPECT of the heart with 99mTc-tetrophosmine, which was carried out at rest and on the background of sublingual administration of nitroglycerine, as well as planar ECG-synchronized scintigraphy of the myocardium according to the protocol: rest - nitroglycerine-mediated - orthostatic tests. Repeat examinations at rest were performed 4-6 weeks after the coronary artery bypass (CAB). The obtained findings showed that sensitivity of perfusion SPECT with 99mTc-tetrophosmine of the myocardium amounted to 85%, specificity to 76%, and diagnostic accuracy to 82%. Calculating the diagnostic parameters of perfusion while using ECG-PS with sublingual administration of nitroglycerine demonstrated that sensitivity of the method amounted to 71%, specificity to 91%, and diagnostic accuracy to 83%. Analyzing the orthostatic test yielded sensitivity equalling 72%, specificity - 84% and diagnostic accuracy - 81%. Sensitivity of assessing myocardial contractility by means of ECG-PS using nitroglycerine amounted to 83%, with specificity of 86% and diagnostic accuracy of 85%. At the same time, sensitivity of the orthostatic test amounted to 80%, specificity to 92%, and diagnostic accuracy to 88%. Hence, carrying out SPECT and ECG-synchronized planar scintigraphy of the heart with 99mTc-tetrophosmine on the background of sublingual administration of nitroglycerine and the orthostatic test makes it possible to simultaneously assess the reserve of myocardial contractility and perfusion, thus strongly suggesting a high informative value of the techniques involved in detecting myocardial viability in patients with postmyocardium infarction cardiosclerosis.
Chernov
V I
VI
Laboratory of Radionuclide Methods of Investigation, Department of Cardiovascular Surgery, Research Institute of Cardiology, Tomsk Scientific Centre, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia. nuclear@cardiolog.tomsk.su
Minin
S M
SM
Makarova
E V
EV
Krivoshchekov
E V
EV
Lishmanov
Iu B
IuB
D000328:Adult; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005996:Nitroglycerin; D011877:Radionuclide Imaging / Q000379:methods*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin