Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan.
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.
Nakajima
Kenichi
K
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
Tamaki
Nagara
N
Kuwabara
Yoichi
Y
Kawano
Masaya
M
Matsunari
Ichiro
I
Taki
Junichi
J
Nishimura
Shigeyuki
S
Yamashina
Akira
A
Ishida
Yoshio
Y
Tomoike
Hitonobu
H
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
D015609:Organotechnetium Compounds