Assessment of nitroglycerine enhanced Tc-99m sestamibi SPECT for the detection of viable myocardium in congestive heart failure

R. Senior, Sanjiv Kaul, U. Raval, A. Lahiri

Research output: Contribution to journalArticle

Abstract

Tc-99m sestamibi imaging (MIBI) is widely used to assess coronary artery disease but its value for the detection of myocardial viability remains controversial. We prospectively evaluated 52 consecutive patients with congestive heart failure (NYHA II-IV) due to coronary artery disease with left ventricular ejection fraction ≤ 35%. Both thallium -201 and Tc-99m sestamibi SPECT imaging were performed at rest following 0.5mg of sublingual nitroglycerine. Systolic wall thickening was assessed by echocardiography. Left ventricle was divided into 12 matching segments for all 3 imaging modalities.. Tracer uptake was scored semiquantitatively (0 = normal; 4 = absent) and viability was present when 50% tracer uptake was seen in a severely dysfunctional segment. The mean tracer uptake was also calculated in the dysfunctional segments using the semiquantitative score for both Tc-99m sestamibi imaging and thallium-201. Of a total of 624 segments, 459 (74%) showed severe dysfunction; of these, Tc-99m sestamibi imaging snowed viability in 318(65%) and thallium-201 imaging in 298(61%) segments (p=NS). Concordance between thallium-201 imaging and Tc-99m sestamibi imaging was 81% (kappa = 0.60). The mean score of thallium-201 and Tc-99m sestamibi imaging were 1.89±0.74 and 1.99±0.66 (p=NS). Thus, nitroglycerine enhanced Tc-99m sestamibi imaging is comparable to thallium-201 for the detection of viability in severely dysfunctional myocardium.

Original languageEnglish (US)
JournalHeart
Volume77
Issue numberSUPPL. 1
StatePublished - May 1997
Externally publishedYes

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Thallium
Nitroglycerin
Single-Photon Emission-Computed Tomography
Myocardium
Heart Failure
Coronary Artery Disease
Stroke Volume
Heart Ventricles
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of nitroglycerine enhanced Tc-99m sestamibi SPECT for the detection of viable myocardium in congestive heart failure. / Senior, R.; Kaul, Sanjiv; Raval, U.; Lahiri, A.

In: Heart, Vol. 77, No. SUPPL. 1, 05.1997.

Research output: Contribution to journalArticle

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abstract = "Tc-99m sestamibi imaging (MIBI) is widely used to assess coronary artery disease but its value for the detection of myocardial viability remains controversial. We prospectively evaluated 52 consecutive patients with congestive heart failure (NYHA II-IV) due to coronary artery disease with left ventricular ejection fraction ≤ 35{\%}. Both thallium -201 and Tc-99m sestamibi SPECT imaging were performed at rest following 0.5mg of sublingual nitroglycerine. Systolic wall thickening was assessed by echocardiography. Left ventricle was divided into 12 matching segments for all 3 imaging modalities.. Tracer uptake was scored semiquantitatively (0 = normal; 4 = absent) and viability was present when 50{\%} tracer uptake was seen in a severely dysfunctional segment. The mean tracer uptake was also calculated in the dysfunctional segments using the semiquantitative score for both Tc-99m sestamibi imaging and thallium-201. Of a total of 624 segments, 459 (74{\%}) showed severe dysfunction; of these, Tc-99m sestamibi imaging snowed viability in 318(65{\%}) and thallium-201 imaging in 298(61{\%}) segments (p=NS). Concordance between thallium-201 imaging and Tc-99m sestamibi imaging was 81{\%} (kappa = 0.60). The mean score of thallium-201 and Tc-99m sestamibi imaging were 1.89±0.74 and 1.99±0.66 (p=NS). Thus, nitroglycerine enhanced Tc-99m sestamibi imaging is comparable to thallium-201 for the detection of viability in severely dysfunctional myocardium.",
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