This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schneider, C. A. Articles by Sechtem, U. Search for Related Content PubMed PubMed Citation Articles by Schneider, C. A. Articles by Sechtem, U.

CLINICAL STUDIES

Significance of rest technetium-99m sestamibi imaging for the prediction of improvement of left ventricular dysfunction after q wave myocardial infarction: importance of infarct location adjusted thresholds

Christian A. Schneider, MD^a, Eberhard Voth, MD^*, Sybille Gawlich, MD^a, Frank M. Baer, MD^a, Michael Horst, MD, Harald Schicha, MD^*, Erland Erdmann, MD, FACC^a and Udo Sechtem, MD, FACC

^a Klinik III für Innere Medizin, Köln, Germany
^* Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln, Köln, Germany
Klinik und Poliklinik für Herz- und Thoraxchirurgie, Stuttgart, Germany
Robert-Bosch Krankenhaus, Stuttgart, Germany

Manuscript received November 14, 1997; revised manuscript received April 24, 1998, accepted May 8, 1998.

Address for correspondence: Dr. C. Schneider, Klinik III für Innere Medizin, Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50934 Köln, Germany

Objective. The value of rest technetium-99m (Tc-99m) sestamibi scintigraphy under oral nitrate medication to predict myocardial viability was examined in patients with chronic infarcts.

Background. The value of rest Tc-99m sestamibi to predict viability in infarct regions has not been fully established because significant underestimation of viability, especially in the inferior myocardial wall, has been reported.

Methods. Forty patients with Q wave myocardial infarction underwent Tc-99m sestamibi single-photon emission computed tomography under nitrate medication before revascularization of the infarct-related artery. Wall motion was quantified from paired angiograms before and 4 months after revascularization. Tracer uptake was quantified in the central infarct region identified on the angiogram.

Results. The average Tc-99m sestamibi uptake in the central infarct region of patients with anterior infarcts and improvement of left ventricular function was significantly higher (68 ± 12%, mean ± SD) than in patients without improvement of function (40 ± 14%, p < 0.02). The average Tc-99m sestamibi uptake in the central infarct region of patients with improvement of function and inferior infarcts was significantly lower (43 ± 7%) than in patients with anterior infarcts (68 ± 12%, p < 0.003), but was significantly higher than in patients with inferior infarction and no improvement of function (31 ± 7%, p < 0.02). Using an infarct location adjusted optimal threshold (50% for anterior infarcts, 35% for inferior infarcts), Tc-99m sestamibi had a positive predictive value of 90% and a negative predictive value of 91% for improvement of left ventricular function.

Conclusion. Quantitative rest Tc-99m sestamibi scintigraphy after oral nitrates reliably predicts improvement of left ventricular function after revascularization if infarct location adjusted thresholds are used.

Abbreviations and Acronyms   FDG = 18F-fluorodeoxyglucose   PET = positron emission tomography   RAO = right anterior oblique   SD = standard deviation   SPECT = single-photon emission computed tomography   Tl-201 = thallium-201   Tc-99m = technetium-99m

This article has been cited by other articles:

				R. Pfister, H. Diedrichs, A. Schiedermair, S. Rosenkranz, M. Hellmich, E. Erdmann, and C. A. Schneider Prognostic impact of NT-proBNP and renal function in comparison to contemporary multi-marker risk scores in heart failure patients Eur J Heart Fail, March 1, 2008; 10(3): 315 - 320. [Abstract] [Full Text] [PDF]

				A. F.L. Schinkel, D. Poldermans, A. Elhendy, and J. J. Bax Assessment of Myocardial Viability in Patients with Heart Failure J. Nucl. Med., July 1, 2007; 48(7): 1135 - 1146. [Abstract] [Full Text] [PDF]

				J J Bax, E E van der Wall, and M Harbinson Radionuclide techniques for the assessment of myocardial viability and hibernation Heart, August 1, 2004; 90(suppl_5): v26 - v33. [Full Text] [PDF]

				R. Sciagra, M. Pellegri, A. Pupi, L. Bolognese, G. Bisi, V. Carnovale, and G. M. Santoro Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., September 1, 2000; 36(3): 739 - 745. [Abstract] [Full Text] [PDF]