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Infarct size determination by technetium 99m sestamibi single-photon emission computed tomography predicts survival
D G Hurrell1, J Milavetz, D O Hodge
1Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Quantifying infarct size using technetium 99m sestamibi SPECT can predict death in chronic coronary artery disease (CAD) patients. However, left ventricular ejection fraction offers greater prognostic value.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Prognostic value of infarct size quantification by technetium 99m sestamibi SPECT in chronic coronary artery disease (CAD) was not established.
- 1323 patients with known or suspected CAD underwent quantitative SPECT imaging for infarct size determination.
- Exclusion criteria included cardiomyopathy, valvular heart disease, or recent myocardial infarction.
Purpose of the Study:
- To establish the prognostic value of infarct size quantification by SPECT in patients with chronic CAD.
- To determine if infarct size is an independent predictor of mortality in this population.
- To compare the prognostic value of infarct size with left ventricular ejection fraction.
Main Methods:
- Quantitative SPECT imaging with 99mTc sestamibi was performed on 1224 patients.
- Patients underwent stress (exercise or pharmacologic) and/or rest imaging.
- Follow-up data was collected for a median of 1.9 years.
Main Results:
- 65% of patients had no measurable infarct.
- Among those with measurable infarcts, mean size was 15.0% +/- 14.5% of the left ventricle.
- Infarct size was an independent predictor of overall death and cardiac death after adjusting for clinical variables (age, diabetes, hypercholesterolemia).
Conclusions:
- Infarct size determination by SPECT 99mTc sestamibi can predict subsequent death in patients with chronic CAD.
- Left ventricular ejection fraction demonstrated greater prognostic value than infarct size.
- Further research may be needed to fully elucidate the role of infarct size in risk stratification.
Background:
The prognostic value of infarct size quantification by technetium 99m sestamibi single-photon emission computed tomography (SPECT) in patients with chronic coronary artery disease (CAD) has not been established. Methods And Results Between September 1994 and May 1995, 1323 patients with known or suspected CAD were referred for perfusion imaging for clinical reasons and had infarct size determined by quantitative SPECT imaging. Patients underwent exercise stress (61%), pharmacologic stress (37%), and rest imaging (3%). Patients were excluded if they had cardiomyopathy, valvular heart disease, or myocardial infarction within 3 weeks of the SPECT study. There were 1224 patients who formed the study group. Follow-up was 94% complete at a median of 1.9 +/- 0.4 years. Sixty-five percent of patients had no measurable infarct. Among the patients with measurable infarcts, the mean infarct size by sestamibi imaging was 15.0% +/- 14.5% of the left ventricle (25% of infarcts /=19% of the left ventricle). By using stepwise regression analysis, age, diabetes, and hypercholesterolemia were all clinical predictors of overall death (P <.05). For cardiac death, only age and diabetes were significant. After adjusting for these clinical variables, infarct size remained an independent predictor of overall death (P =. 001) and survival free of cardiac death (P =.0002). However, when first-pass left ventricular ejection fraction was added to the models, infarct size was no longer significant.
Conclusions:
Infarct size determination by SPECT (99m)Tc sestamibi can predict subsequent death in patients with chronic CAD, although ejection fraction appears to have greater prognostic value.