Related Experiment Video
Updated: Jul 2, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Risk stratification of patients with prior myocardial infarction and advanced left ventricular dysfunction by gated
Itsuro Morishima1, Takahito Sone, Hideyuki Tsuboi
1Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Insights
Technetium 99m tetrofosmin SPECT imaging identifies patients at high risk for sudden cardiac death. Perfusion defect volume is the strongest predictor, aiding targeted implantable cardiac defibrillator therapy for patients with left ventricular dysfunction.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- The Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) demonstrated implantable cardiac defibrillator (ICD) benefits in patients post-myocardial infarction with left ventricular (LV) dysfunction.
- A need exists for noninvasive predictors to identify high-risk subgroups for ICD therapy.
Purpose of the Study:
- To evaluate technetium 99m tetrofosmin electrocardiogram-gated single photon emission computed tomography (SPECT) at rest for predicting arrhythmic death risk.
- To identify patients who would most benefit from ICD implantation.
Main Methods:
- 106 patients meeting MADIT-II criteria underwent resting Tc-99m tetrofosmin SPECT.
- Follow-up for lethal arrhythmic events (sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death) over a mean of 30 months.
- Analysis of LV ejection fraction, volumes, and perfusion defect volume as predictors.
Main Results:
- 14 patients experienced lethal arrhythmic events.
- Patients with events had lower LV ejection fraction, larger LV volumes, and greater perfusion defect volume.
- Myocardial defect volume was the strongest predictor of lethal arrhythmic events via ROC analysis.
Conclusions:
- Perfusion defect volume on Tc-99m tetrofosmin scintigraphy is a pivotal predictor of lethal arrhythmic events and sudden cardiac death.
- Tc-99m tetrofosmin SPECT can help identify patients with LV dysfunction at higher risk for arrhythmic death, optimizing ICD therapy selection.
Background:
The Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) has shown that the prophylactic implantable cardiac defibrillator improves the survival rate of patients with prior myocardial infarction and advanced left ventricular (LV) dysfunction. However, a more accurate noninvasive predictor should be found to identify subgroups at high risk, one that would allow implantable cardiac defibrillator therapy to be directed specifically to the patients who would benefit most.
Methods And Results:
To elucidate whether technetium 99m tetrofosmin electrocardiogram-gated single photon emission computed tomography (SPECT) imaging at rest can determine the risk of arrhythmic death, 106 patients who met the MADIT-II criteria (LV ejection fraction
Conclusion:
Our results confirm that perfusion defect volume by Tc-99m tetrofosmin scintigraphy is the most pivotal predictor of the future occurrence of lethal arrhythmic events and of sudden cardiac death. Tc-99m tetrofosmin SPECT images may assist in identifying subsets of patients with a greater likelihood of arrhythmic death among patients with LV dysfunction.
