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Sestamibi SPECT in the detection of myocardial viability in patients with chronic ischemic left ventricular
W Acampa1, M Petretta, L Florimonte
1Nuclear Medicine Center of the National Council of Research, Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy.
Insights
Visual and quantitative analysis of resting sestamibi SPECT show similar accuracy in predicting left ventricular (LV) function recovery after revascularization in patients with chronic myocardial infarction and LV dysfunction.
Area of Science:
- Nuclear Medicine
- Cardiology
- Medical Imaging
Background:
- Technetium 99m sestamibi cardiac scintigraphy is a standard for assessing myocardial viability in patients with chronic ischemic left ventricular (LV) dysfunction.
- Limited data exist comparing visual and quantitative analysis of tomographic imaging for myocardial viability assessment.
Purpose of the Study:
- To directly compare visual and quantitative analysis of resting sestamibi single-photon emission computed tomography (SPECT) in identifying viable myocardium.
- To evaluate the prediction of recovery of LV function after revascularization based on these analyses.
Main Methods:
- 65 patients with prior myocardial infarction and LV dysfunction underwent resting sestamibi SPECT and echocardiography.
- Regional tracer distribution was assessed visually and quantitatively; LV function was evaluated by echocardiography.
- Echocardiography was repeated 12 months post-revascularization to assess functional recovery.
Main Results:
- Quantitative analysis identified viable segments with higher accuracy (73%) compared to visual analysis (59%) (P<.05).
- Accuracy for nonviable segments was similar between visual (81%) and quantitative (74%) analysis (P=.3).
- Overall accuracy for detecting myocardial viability was comparable (ROC areas: visual 0.79, quantitative 0.81; P=NS), with 78% concordance.
Conclusions:
- Both visual and quantitative analysis of resting sestamibi SPECT demonstrate similar overall accuracy in predicting LV function recovery post-revascularization.
- These imaging techniques are valuable tools for managing patients with chronic ischemic heart disease.
Background:
Technetium 99m sestamibi cardiac scintigraphy is widely used as a means of predicting myocardial viability in patients with chronic ischemic left ventricular (LV) dysfunction. No data are available comparing the results of visual and quantitative analysis of tomographic imaging in the assessment of myocardial viability. The aim of this study was to directly compare visual and quantitative analysis of resting sestamibi single photon emission computed tomography in the identification of viable myocardium in patients with chronic LV dysfunction.
Methods And Results:
Sixty-five patients with an earlier myocardial infarction and LV dysfunction that had occurred within 1 week underwent echocardiography and resting sestamibi SPECT. In each patient, regional tracer distribution was visually assessed and quantitatively measured in 13 segments. Regional LV function was evaluated in corresponding segments by means of echocardiography. All patients underwent revascularization, and echocardiography was repeated 12 months later as a means of assessing the recovery of regional LV function. Among all akinetic or dyskinetic revascularized segments, 66 of 112 viable segments (59%) and 85 of 100 nonviable segments (81%) were identified by means of visual analysis. Eighty-two of 112 viable segments (73%; P<.05 vs. visual analysis) and 74 of 100 nonviable segments (74%; P = .3 vs. visual analysis) were identified by means of quantitative analysis, with a threshold of 55%. Receiver operating characteristic curve areas constructed by using visual and quantitative analyses for the detection of myocardial viability in all 212 akinetic or dyskinetic segments were 0.79+/-0.04 and 0.81+/-0.03, respectively (P = not significant). Overall concordance in the detection of myocardial viability between visual and quantitative analysis was observed in 165 of akinetic or dyskinetic dysfunctional segments (78%), with a kappa value of 0.6.
Conclusions:
The results of this study demonstrate that, in patients with chronic myocardial infarction and LV dysfunction, visual and quantitative analysis of sestamibi tomographic images at rest have similar overall accuracy in predicting the recovery of LV function after coronary revascularization procedures.