Comparison of baseline-nitrate technetium-99m sestamibi with rest-redistribution thallium-201 tomography in detecting viable hibernating myocardium and predicting postrevascularization recovery

J Am Coll Cardiol. 1997 Aug;30(2):384-91. doi: 10.1016/s0735-1097(97)00192-7.

Abstract

Objectives: This study aimed to define the optimal criteria for detecting viable myocardium with rest-redistribution thallium-201 (Tl-201) or baseline-nitrate technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) using discriminant analysis and to compare the accuracy of the two tracers in predicting postrevascularization recovery.

Background: Rest-redistribution Tl-201 imaging is currently used for detection of myocardial viability, but the optimal variables for territory classification have not yet been defined. Although Tc-99m sestamibi is reportedly less effective than Tl-201, its reliability can be increased by injecting it during nitrate infusion.

Methods: In 35 patients with left ventricular (LV) dysfunction, tracer activity within asynergic coronary territories was quantified on rest and redistribution Tl-201 and baseline and nitrate Tc-99m sestamibi SPECT. Asynergic territory viability was evaluated on the basis of the postrevascularization functional outcome.

Results: Percent activity within asynergic territories was significantly influenced by their viability (p < 0.005) and the type of acquisition (p < 0.0001) but not by the tracer used. Discriminant analysis identified redistribution Tl-201 activity and nitrate-induced Tc-99m sestamibi activity change as the two most significant predictors of postrevascularization recovery. The discriminant function defined for Tl-201, including redistribution activity and reversibility, correctly classified 38 of 56 asynergic territories, whereas that for Tc-99m sestamibi, including nitrate-induced activity change and activity in nitrate images, correctly classified 43 territories.

Conclusions: Redistribution activity is more important than reversibility when differentiating viable from nonviable territories using rest-redistribution Tl-201. In Tc-99m sestamibi SPECT, nitrate-induced activity changes are particularly useful in identifying myocardial viability. Baseline-nitrate Tc-99m sestamibi SPECT appears no less effective than rest-redistribution Tl-201 in predicting postrevascularization recovery.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Heart / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / surgery*
  • Myocardial Revascularization*
  • Myocardial Stunning / diagnostic imaging*
  • Nitrates
  • Prognosis
  • Technetium Tc 99m Sestamibi*
  • Thallium Radioisotopes*
  • Tissue Survival / physiology
  • Tomography, Emission-Computed, Single-Photon*
  • Ventricular Dysfunction, Left / diagnostic imaging

Substances

  • Nitrates
  • Thallium Radioisotopes
  • Technetium Tc 99m Sestamibi