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Myocardial risk area defined by technetium-99m sestamibi imaging during percutaneous transluminal coronary
H L Haronian1, M S Remetz, A J Sinusas
1Department of Medicine (Section of Cardiovascular Medicine), Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Coronary angiography risk assessment for myocardial area at risk is not well validated. Quantitative myocardial perfusion imaging with technetium-99m sestamibi offers a more accurate assessment of the functional significance of coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Radiology
Background:
- Coronary angiography is commonly used for semiquantitative estimation of myocardial area at risk.
- This angiographic approach lacks robust validation.
- Technetium-99m sestamibi allows for quantitative assessment of the nonperfused area at risk due to minimal redistribution.
Purpose of the Study:
- To compare the assessment of myocardial area at risk in patients with coronary artery stenosis.
- To evaluate coronary angiography versus quantitative myocardial perfusion imaging using technetium-99m sestamibi.
Main Methods:
- Thirty-nine patients undergoing coronary angioplasty were studied.
- Technetium-99m sestamibi was injected during angioplasty balloon inflation, with imaging performed post-procedure and 24-48 hours later.
- Myocardial risk area was quantified using perfusion imaging and compared with five angiographic scoring methods.
Main Results:
- Scintigraphic risk area varied between planar (14±15) and tomographic (39±16) imaging.
- Patients with infarction had larger scintigraphic risk areas (22±17 vs. 7±8, p=0.003).
- Angiographic risk scores showed only moderate correlation (r=0.54-0.65) with technetium-99m sestamibi derived risk area.
Conclusions:
- Coronary angiography does not accurately correlate with quantitative myocardial perfusion imaging for assessing the area at risk.
- Coronary anatomy alone does not predict the functional significance of coronary artery disease.
Objectives:
The purpose of this study was to compare the assessment of myocardial area at risk in patients with coronary artery stenosis by coronary angiography and quantitative myocardial perfusion imaging with technetium-99m sestamibi.
Background:
Decisions concerning patient management frequently rely on semiquantitative angiographic estimation of the myocardial area at risk, although this approach has not been well validated. Technetium-99m sestamibi is a perfusion imaging agent with little redistribution after initial myocardial uptake. This characteristic allows for injection during angioplasty and later imaging for visualization and quantitation of the nonperfused area at risk.
Methods:
Thirty-nine patients referred for coronary angioplasty were studied. Technetium-99m sestamibi was injected intravenously during angioplasty balloon inflation. Planar (33 patients) or tomographic (6 patients) imaging was performed after completion of angioplasty. Imaging was repeated 24 to 48 h later. Myocardial risk area (perfusion defect on angioplasty image) was quantified as an integral using circumferential count distribution profiles and normal reference. Angiographic risk area was assessed using five scoring methods.
Results:
The scintigraphic risk area was 14 +/- 15 on planar images and 39 +/- 16 on tomography. Scintigraphic risk area of patients with infarction was larger than in patients without (22 +/- 17 versus 7 +/- 8, p = 0.003). The left anterior descending coronary artery had a larger mean risk area than other vessels (22 +/- 15 versus 7 +/- 11, p = 0.002). The presence of angiographic collateral channels was associated with smaller risk areas. Angiographic risk scores correlated only moderately with the technetium-99m sestamibi risk area (r = 0.54 to 0.65), with considerable spread of data.
Conclusions:
Area at risk estimated from coronary angiography does not correlate well with that from quantitative myocardial perfusion imaging with technetium-99m sestamibi. These findings emphasize that the functional significance of coronary artery disease is not predicted by coronary anatomy alone.