Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy

Roxy Senior, Sanjiv Kaul, Usha Raval, Avijit Lahiri

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background. Nitrate-enhanced perfusion imaging has been shown to detect viability in dysfunctional myocardium, but nitrate-enhanced technetium 99m sestamibi has not been compared with nitrate-enhanced thallium 201. Methods and Results. Fifty-six patients with ischemic cardiomyopathy and heart failure (New York Heart Association classes II-IV) were scheduled for revascularization. Through use of a matching 12-segment model, nitrate-enhanced Tl-201 and Tc-99m sestamibi uptake at rest was assessed by 2 sets of blinded investigators. All single photon emission computed tomography data sets were read separately. Additional exercise Tc-99m sestamibi single photon emission computed tomography was performed on a separate day. Myocardial viability was thought to be present when the tracer uptake score was less than 3 (normal, 0; absent, 4). Of the 56 patients scheduled to undergo revascularization, only 23 (41 %) underwent the procedure and the remainder continued medical therapy. Functional assessment by rest echocardiography was performed at 21 ± 8 months, and survival was determined at 40 ± 18 months. The baseline clinical and hemodynamic parameters were similar in the revascularization (n = 23) and medical therapy (n = 33) groups. Perfusion scores with nitrate-enhanced Tl-201 and Tc-99m sestamibi were similar in dysfunctional segments. Stress Tc-99m sestamibi reversible defects predicted significant improvement in left ventricular function compared with those without defects (P <.01) after revascularization. Cox regression model showed that when at least 5 reversible segments were viable, revascularization produced greater improvements in New York Heart Association class, a better trend toward survival (P = .07 for Tl-201 and P = .06 for Tc-99m), and a significantly greater impact on reverse remodeling. Conclusions. Myocardial viability determined by nitrate-enhanced Tl-201 and myocardial viability determined by Tc-99m sestamibi are equivalent for predicting functional improvements, remodeling, and survival after revascularization in patients with ischemic cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)454-462
Number of pages9
JournalJournal of Nuclear Cardiology
Volume9
Issue number5
DOIs
StatePublished - Sep 2002
Externally publishedYes

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Myocardial Revascularization
Cardiomyopathies
Nitrates
Mortality
Single-Photon Emission-Computed Tomography
Survival
Technetium Tc 99m Sestamibi
Perfusion Imaging
Left Ventricular Function
Proportional Hazards Models
Echocardiography
Myocardium
Heart Failure
Perfusion
Hemodynamics
Research Personnel
Exercise
Therapeutics

Keywords

  • Ischemic cardiomyopathy
  • Myocardial viability
  • Revascularization
  • Tc-99m sestamibi

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{fc63e1689590479095e595eff213fe01,
title = "Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy",
abstract = "Background. Nitrate-enhanced perfusion imaging has been shown to detect viability in dysfunctional myocardium, but nitrate-enhanced technetium 99m sestamibi has not been compared with nitrate-enhanced thallium 201. Methods and Results. Fifty-six patients with ischemic cardiomyopathy and heart failure (New York Heart Association classes II-IV) were scheduled for revascularization. Through use of a matching 12-segment model, nitrate-enhanced Tl-201 and Tc-99m sestamibi uptake at rest was assessed by 2 sets of blinded investigators. All single photon emission computed tomography data sets were read separately. Additional exercise Tc-99m sestamibi single photon emission computed tomography was performed on a separate day. Myocardial viability was thought to be present when the tracer uptake score was less than 3 (normal, 0; absent, 4). Of the 56 patients scheduled to undergo revascularization, only 23 (41 {\%}) underwent the procedure and the remainder continued medical therapy. Functional assessment by rest echocardiography was performed at 21 ± 8 months, and survival was determined at 40 ± 18 months. The baseline clinical and hemodynamic parameters were similar in the revascularization (n = 23) and medical therapy (n = 33) groups. Perfusion scores with nitrate-enhanced Tl-201 and Tc-99m sestamibi were similar in dysfunctional segments. Stress Tc-99m sestamibi reversible defects predicted significant improvement in left ventricular function compared with those without defects (P <.01) after revascularization. Cox regression model showed that when at least 5 reversible segments were viable, revascularization produced greater improvements in New York Heart Association class, a better trend toward survival (P = .07 for Tl-201 and P = .06 for Tc-99m), and a significantly greater impact on reverse remodeling. Conclusions. Myocardial viability determined by nitrate-enhanced Tl-201 and myocardial viability determined by Tc-99m sestamibi are equivalent for predicting functional improvements, remodeling, and survival after revascularization in patients with ischemic cardiomyopathy.",
keywords = "Ischemic cardiomyopathy, Myocardial viability, Revascularization, Tc-99m sestamibi",
author = "Roxy Senior and Sanjiv Kaul and Usha Raval and Avijit Lahiri",
year = "2002",
month = "9",
doi = "10.1067/mnc.2002.123913",
language = "English (US)",
volume = "9",
pages = "454--462",
journal = "Journal of Nuclear Cardiology",
issn = "1071-3581",
publisher = "Springer New York",
number = "5",

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TY - JOUR

T1 - Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy

AU - Senior, Roxy

AU - Kaul, Sanjiv

AU - Raval, Usha

AU - Lahiri, Avijit

PY - 2002/9

Y1 - 2002/9

N2 - Background. Nitrate-enhanced perfusion imaging has been shown to detect viability in dysfunctional myocardium, but nitrate-enhanced technetium 99m sestamibi has not been compared with nitrate-enhanced thallium 201. Methods and Results. Fifty-six patients with ischemic cardiomyopathy and heart failure (New York Heart Association classes II-IV) were scheduled for revascularization. Through use of a matching 12-segment model, nitrate-enhanced Tl-201 and Tc-99m sestamibi uptake at rest was assessed by 2 sets of blinded investigators. All single photon emission computed tomography data sets were read separately. Additional exercise Tc-99m sestamibi single photon emission computed tomography was performed on a separate day. Myocardial viability was thought to be present when the tracer uptake score was less than 3 (normal, 0; absent, 4). Of the 56 patients scheduled to undergo revascularization, only 23 (41 %) underwent the procedure and the remainder continued medical therapy. Functional assessment by rest echocardiography was performed at 21 ± 8 months, and survival was determined at 40 ± 18 months. The baseline clinical and hemodynamic parameters were similar in the revascularization (n = 23) and medical therapy (n = 33) groups. Perfusion scores with nitrate-enhanced Tl-201 and Tc-99m sestamibi were similar in dysfunctional segments. Stress Tc-99m sestamibi reversible defects predicted significant improvement in left ventricular function compared with those without defects (P <.01) after revascularization. Cox regression model showed that when at least 5 reversible segments were viable, revascularization produced greater improvements in New York Heart Association class, a better trend toward survival (P = .07 for Tl-201 and P = .06 for Tc-99m), and a significantly greater impact on reverse remodeling. Conclusions. Myocardial viability determined by nitrate-enhanced Tl-201 and myocardial viability determined by Tc-99m sestamibi are equivalent for predicting functional improvements, remodeling, and survival after revascularization in patients with ischemic cardiomyopathy.

AB - Background. Nitrate-enhanced perfusion imaging has been shown to detect viability in dysfunctional myocardium, but nitrate-enhanced technetium 99m sestamibi has not been compared with nitrate-enhanced thallium 201. Methods and Results. Fifty-six patients with ischemic cardiomyopathy and heart failure (New York Heart Association classes II-IV) were scheduled for revascularization. Through use of a matching 12-segment model, nitrate-enhanced Tl-201 and Tc-99m sestamibi uptake at rest was assessed by 2 sets of blinded investigators. All single photon emission computed tomography data sets were read separately. Additional exercise Tc-99m sestamibi single photon emission computed tomography was performed on a separate day. Myocardial viability was thought to be present when the tracer uptake score was less than 3 (normal, 0; absent, 4). Of the 56 patients scheduled to undergo revascularization, only 23 (41 %) underwent the procedure and the remainder continued medical therapy. Functional assessment by rest echocardiography was performed at 21 ± 8 months, and survival was determined at 40 ± 18 months. The baseline clinical and hemodynamic parameters were similar in the revascularization (n = 23) and medical therapy (n = 33) groups. Perfusion scores with nitrate-enhanced Tl-201 and Tc-99m sestamibi were similar in dysfunctional segments. Stress Tc-99m sestamibi reversible defects predicted significant improvement in left ventricular function compared with those without defects (P <.01) after revascularization. Cox regression model showed that when at least 5 reversible segments were viable, revascularization produced greater improvements in New York Heart Association class, a better trend toward survival (P = .07 for Tl-201 and P = .06 for Tc-99m), and a significantly greater impact on reverse remodeling. Conclusions. Myocardial viability determined by nitrate-enhanced Tl-201 and myocardial viability determined by Tc-99m sestamibi are equivalent for predicting functional improvements, remodeling, and survival after revascularization in patients with ischemic cardiomyopathy.

KW - Ischemic cardiomyopathy

KW - Myocardial viability

KW - Revascularization

KW - Tc-99m sestamibi

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