Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability. Correlation with echocardiography and rest thallium-201 scintigraphy

Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California 90048.

OBJECTIVES. This study compares technetium-99m sestamibi (sestamibi) electrocardiographic (ECG) gated single-photon emission computed tomography (gated SPECT) and echocardiography for the evaluation of myocardial function and assesses the feasibility of single-injection, single-acquisition stress perfusion/rest function technetium-99m sestamibi-gated SPECT as an alternative to conventional stress/rest imaging for assessment of myocardial perfusion and viability. BACKGROUND. Simultaneous assessment of stress perfusion and rest function is possible with gated SPECT acquisition of stress-injected technetium-99m sestamibi. METHODS. Rest thallium-201 SPECT followed by stress sestamibi-gated SPECT (acquired 0.5 to 1 h after sestamibi injection) was performed in 58 patients. Echocardiography was performed immediately after or before gated SPECT in 43 of the patients. All studies were analyzed by semiquantitative visual scoring. Sestamibi-gated SPECT studies were read for stress perfusion and rest wall motion and thickening. Reversibility on sestamibi-gated SPECT was defined as the presence of a definite stress defect with normal or mildly impaired wall motion or thickening on gated SPECT. RESULTS. There was high segmental score agreement between gated SPECT and echocardiography for wall motion (91%, kappa = 0.68, p < 0.001) and thickening (90%, kappa = 0.62, p < 0.001). Correlation for global wall motion (r = 0.98, p < 0.001) and thickening (r = 0.96, p < 0.001) scores between the two modalities was excellent. In 32 patients without previous myocardial infarction, there was excellent agreement for reversibility between stress sestamibi-gated SPECT and rest thallium-201/stress sestamibi (98%, kappa = 0.93, p < 0.01). However, in 26 patients with previous infarction, discordance between the two approaches was frequent, with 26% (20 of 78) of nonreversible defects by stress sestamibi-gated SPECT being reversible by rest thallium-201/stress sestamibi and 21% (23 of 112) of reversible defects by stress sestamibi-gated SPECT being nonreversible by rest thallium-201/stress sestamibi. CONCLUSIONS. Gated SPECT of stress-injected sestamibi correlates well with echocardiographic assessment of regional function and thus adds information to perfusion SPECT. In patients without previous myocardial infarction, a single-injection stress perfusion/rest function approach using sestamibi-gated SPECT can substitute for conventional stress/rest myocardial perfusion imaging, adding a rest perfusion study only if there are nonreversible defects or consideration of attenuation artifacts. In patients with previous myocardial infarction, the gated SPECT approach does not replace the need for a rest perfusion study.

This article has been cited by other articles:

				D. Patel, V. J.B. Robinson, R. B. Arteaga, and J. W. Thornton Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization J. Nucl. Med., May 1, 2008; 49(5): 746 - 751. [Abstract] [Full Text] [PDF]

				T. Schepis, O. Gaemperli, P. Koepfli, I. Valenta, K. Strobel, A. Brunner, S. Leschka, L. Desbiolles, L. Husmann, H. Alkadhi, et al. Comparison of 64-Slice CT with Gated SPECT for Evaluation of Left Ventricular Function J. Nucl. Med., August 1, 2006; 47(8): 1288 - 1294. [Abstract] [Full Text] [PDF]

				A. C. Lapeyre III, E. Klodas, P. J. Rogers, L. J. Sinak, T. C. Hammell, M. K. O'Connor, and R. J. Gibbons Quantitation of Regional Ejection Fractions Using Gated Tomographic Imaging With 99mTc-Sestamibi Chest, March 1, 2005; 127(3): 778 - 786. [Abstract] [Full Text] [PDF]

				A. K. Paul and H. A. Nabi Gated Myocardial Perfusion SPECT: Basic Principles, Technical Aspects, and Clinical Applications J. Nucl. Med. Technol., December 1, 2004; 32(4): 179 - 187. [Abstract] [Full Text] [PDF]

				S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF]

				M. Leoncini, F. Bellandi, R. Sciagra, M. Maioli, A. Toso, A. Coppola, S. Sestini, A. Mennuti, R. P. Dabizzi, and A. Pupi Gated SPECT Evaluation of the Relationship Between Admission Troponin I, Myocardial Salvage, and Functional Recovery in Acute Myocardial Infarction Treated by Abciximab and Early Primary Angioplasty J. Nucl. Med., May 1, 2004; 45(5): 739 - 744. [Abstract] [Full Text] [PDF]

				S. Fleischmann, P. Koepfli, M. Namdar, C. A. Wyss, R. Jenni, and P. A. Kaufmann Gated 99mTc-Tetrofosmin SPECT for Discriminating Infarct from Artifact in Fixed Myocardial Perfusion Defects J. Nucl. Med., May 1, 2004; 45(5): 754 - 759. [Abstract] [Full Text] [PDF]

				R. Sciagra, M. Giaccardi, M. C. Porciani, A. Colella, A. Michelucci, P. Pieragnoli, G. Gensini, A. Pupi, and L. Padeletti Myocardial Perfusion Imaging Using Gated SPECT in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy J. Nucl. Med., February 1, 2004; 45(2): 164 - 168. [Abstract] [Full Text] [PDF]

				F. C. Aepfelbacher, S. B. Yeon, K. K. L. Ho, J. A. Parker, and P. G. Danias ECG-Gated 99mTc Single-Photon Emission CT for Assessment of Right Ventricular Structure and Function: Is the Information Provided Similar to Echocardiography? Chest, July 1, 2003; 124(1): 227 - 232. [Abstract] [Full Text] [PDF]

				L. Spinelli, M. Petretta, W. Acampa, W. He, A. Petretta, D. Bonaduce, and A. Cuocolo Prognostic Value of Combined Assessment of Regional Left Ventricular Function and Myocardial Perfusion by Dobutamine and Rest Gated SPECT in Patients with Uncomplicated Acute Myocardial Infarction J. Nucl. Med., July 1, 2003; 44(7): 1023 - 1029. [Abstract] [Full Text] [PDF]

				J. Taki, T. Higuchi, K. Nakajima, I. Matsunari, E.-H. Hwang, H. Bunko, M. Kawasuji, G. Watanabe, and N. Tonami Electrocardiographic Gated 99mTc-MIBI SPECT for Functional Assessment of Patients After Coronary Artery Bypass Surgery: Comparison of Wall Thickening and Wall Motion Analysis J. Nucl. Med., May 1, 2002; 43(5): 589 - 595. [Abstract] [Full Text] [PDF]

				L. Emmett, R. M. Iwanochko, M. R. Freeman, A. Barolet, D. S. Lee, and M. Husain Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses J. Am. Coll. Cardiol., March 20, 2002; 39(6): 991 - 998. [Abstract] [Full Text] [PDF]

				T. Sharir, D. S. Berman, P. B. Waechter, J. Areeda, P. B. Kavanagh, J. Gerlach, X. Kang, and G. Germano Quantitative Analysis of Regional Motion and Thickening by Gated Myocardial Perfusion SPECT: Normal Heterogeneity and Criteria for Abnormality J. Nucl. Med., November 1, 2001; 42(11): 1630 - 1638. [Abstract] [Full Text] [PDF]

				J. R. Corbett and E. P. Ficaro Gated SPECT and the Visual Gold Standard: Gold Standard or Not? J. Nucl. Med., November 1, 2001; 42(11): 1639 - 1642. [Full Text] [PDF]

				A. Meyers, J. Ballow, L. Topham, R. Rainer, and C. Field Assessing Coronary Artery Disease with Thallium-201 Rest and Technetium-99m-Sestamibi Stress Testing at Two Centers J. Nucl. Med. Technol., December 1, 2000; 28(4): 248 - 251. [Abstract] [Full Text] [PDF]

				C. D. L. Bavelaar-Croon, H. W. M. Kayser, E. E. van der Wall, A. de Roos, P. Dibbets-Schneider, E. K. J. Pauwels, G. Germano, and D. E. Atsma Left Ventricular Function: Correlation of Quantitative Gated SPECT and MR Imaging over a Wide Range of Values Radiology, November 1, 2000; 217(2): 572 - 575. [Abstract] [Full Text]

				S. Borges-Neto, A. Javaid, L. K. Shaw, D. F. Kong, M. W. Hanson, R. A. Pagnanelli, G. Ravizzini, and R. E. Coleman Poststress Measurements of Left Ventricular Function with Gated Perfusion SPECT: Comparison with Resting Measurements by Using a Same-Day Perfusion-Function Protocol Radiology, May 1, 2000; 215(2): 529 - 533. [Abstract] [Full Text]

				R. J Gibbons IMAGING TECHNIQUES: Myocardial perfusion imaging Heart, March 1, 2000; 83(3): 355 - 360. [Full Text]

				T. Sharir, G. Germano, P. B. Kavanagh, S. Lai, I. Cohen, H. C. Lewin, J. D. Friedman, M. J. Zellweger, and D. S. Berman Incremental Prognostic Value of Post-Stress Left Ventricular Ejection Fraction and Volume by Gated Myocardial Perfusion Single Photon Emission Computed Tomography Circulation, September 7, 1999; 100(10): 1035 - 1042. [Abstract] [Full Text] [PDF]

				E. Tadamura, T. Kudoh, M. Motooka, M. Inubushi, S. Shirakawa, N. Hattori, T. Okada, T. Matsuda, T. Koshiji, K. Nishimura, et al. Assessment of regional and global left ventricular function by reinjection Tl-201 and rest Tc-99m sestamibi ECG-gated SPECT: Comparison with three-dimensional magnetic resonance imaging J. Am. Coll. Cardiol., March 15, 1999; 33(4): 991 - 997. [Abstract] [Full Text] [PDF]

				T S Hornung, E J Bernard, E T Jaeggi, R B Howman-Giles, D S Celermajer, and R E Hawker Myocardial perfusion defects and associated systemic ventricular dysfunction in congenitally corrected transposition of the great arteries Heart, October 1, 1998; 80(4): 322 - 326. [Abstract] [Full Text]

				V. Sansoy, D. K. Glover, D. D. Watson, M. Ruiz, W. H. Smith, J. P. Simanis, and G. A. Beller Comparison of Thallium-201 Resting Redistribution With Technetium-99m–Sestamibi Uptake and Functional Response to Dobutamine for Assessment of Myocardial Viability Circulation, August 15, 1995; 92(4): 994 - 1004. [Abstract] [Full Text]

				T. Yabe, K. Mitsunami, T. Inubushi, and M. Kinoshita Quantitative Measurements of Cardiac Phosphorus Metabolites in Coronary Artery Disease by 31P Magnetic Resonance Spectroscopy Circulation, July 1, 1995; 92(1): 15 - 23. [Abstract] [Full Text]

				D. D. Miller The Growing Flood of Technetium-99m Myocardial Perfusion Agents : More Water . . . or More Mud? Circulation, January 15, 1995; 91(2): 555 - 558. [Abstract] [Full Text]