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Serial changes on quantitative myocardial perfusion SPECT in patients undergoing revascularization or conservative
D S Berman1, X Kang, E F Schisterman
1Department of Imaging, Division of Nuclear Medicine, and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.bermand@cshs.org
Summary
Coronary revascularization and conservative therapy can improve myocardial perfusion over time. Patients with extensive defects may see greater improvement with revascularization.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Myocardial perfusion changes after revascularization or medical therapy are not well understood.
- Quantitative myocardial perfusion single-photon emission computed tomography (SPECT) is a key imaging technique.
Purpose of the Study:
- To assess long-term effects of coronary revascularization versus conservative therapy on myocardial perfusion.
- To evaluate serial quantitative myocardial perfusion SPECT in patients undergoing different treatments.
Main Methods:
- Observational study of 421 patients with abnormal baseline quantitative myocardial perfusion SPECT.
- Serial rest thallium-201/stress technetium-99m sestamibi SPECT performed at least 1 year apart.
- Patients categorized into small, intermediate, and extensive baseline stress defect groups; treatments included revascularization or conservative therapy.
Main Results:
- Patients with extensive defects undergoing revascularization showed significant reductions in stress and reversible defect extent.
- Patients with extensive defects on conservative therapy had a small reduction in stress defect extent.
- Modest improvements in reversible defect extent were observed in intermediate defect groups regardless of therapy; small defect groups showed no significant changes.
Conclusions:
- Improvement in quantitative myocardial perfusion abnormalities can occur over time with both revascularization and conservative therapy.
- Revascularization may lead to greater improvement in patients with extensive myocardial perfusion defects.