title: Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan.
abstract: BACKGROUND
  Prediction of left ventricular functional recovery is important after myocardial infarction. The impact of quantitative perfusion and motion analyses with gated single-photon emission computed tomography (SPECT) on predictive ability has not been clearly defined in multi-center studies.
  
  
  METHODS
  A total of 252 patients with recent myocardial infarction (n = 74) and old myocardial infarction (n = 175) were registered from 25 institutions. All patients underwent resting gated SPECT using (99m)Tc-hexakis-2-methoxy-isobutyl isonitrile (MIBI) and repeated the study after revascularization after an average follow-up period of 132 +/- 81 days. Visual and quantitative assessment of perfusion and wall motion were performed in 5,040 segments.
  
  
  RESULTS
  Non-gated segmental percent uptake and end-systolic (ES) percent uptake were good predictors of wall motion recovery and significantly differed between improved and non-improved groups (66 +/- 17% and 55 +/- 18%, p < 0.0001 for non-gated; 64 +/- 16% and 51 +/- 17% for ES percent uptake, p < 0.0001). The area under the curve of receiver operating characteristics curve for non-gated percent uptake, ES percent uptake, end-diastolic percent uptake and visual perfusion defect score was 0.70, 0.71, 0.61, and 0.56, respectively. Sensitivity and specificity of percent uptake were 68% and 64% for non-gated map and 80% and 52% for ES percent uptake map. An optimal threshold for predicting segmental improvement was 63% for non-gated and 52% for ES percent uptake values.
  
  
  CONCLUSIONS
  Segmental (99m)Tc-MIBI uptake provided a useful predictor of wall motion improvement. Application of quantitative approach with non-gated and ES percent uptake enhanced predictive accuracy over visual analysis particularly in a multi-center study.
authors.affiliation: Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. nakajima@med.kanazawa-u.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakajima
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kuwabara
authors.forename: Masaya
authors.initials: M
authors.lastname: Kawano
authors.forename: Ichiro
authors.initials: I
authors.lastname: Matsunari
authors.forename: Junichi
authors.initials: J
authors.lastname: Taki
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ishida
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D009068:Movement; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D015609:Organotechnetium Compounds; D012372:ROC Curve; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds