Circulation, Vol 89, 2552-2561, Copyright © 1994 by American Heart Association
JE Udelson, PS Coleman, J Metherall, NG Pandian, AR Gomez, JL Griffith, NL Shea, E Oates and MA Konstam
BACKGROUND: Regional 201Tl activity after resting injection, imaged early
and after redistribution, reflects viable myocardium and can predict
improved isotope uptake as well as regional and global ventricular function
after revascularization. 99mTc-sestamibi, a perfusion tracer with favorable
imaging characteristics, has distinct kinetics compared with 201Tl,
demonstrating minimal redistribution; this property may give 201Tl an
advantage for detecting viable myocardium, particularly in segments with
resting hypoperfusion. The purpose of this study was to compare regional
activities of 201Tl and 99mTc-sestamibi after resting injections in
patients with coronary artery disease and regional or global left
ventricular dysfunction and to assess their comparative abilities for
predicting recovery of severe regional ventricular dysfunction after
revascularization. METHODS AND RESULTS: Qualitative and quantitative
comparisons of rest and redistribution 201Tl activity and sestamibi
activity 1 hour after rest injection were performed in 31 patients with
coronary artery disease and left ventricular dysfunction. Quantitative
analysis of three short- axis tomograms per patient was performed by use of
circumferential profiles that allowed analysis of 12 segments per patient.
Two- dimensional echocardiography was used to assess wall motion and
thickening in segments corresponding to the single photon emission computed
tomography data. Concordance between regional 201Tl activity at
redistribution imaging and regional sestamibi activity by semiquantitative
visual analysis demonstrated concordant regional activity in 87% of
segments; among discordant segments, no significant skew was seen,
indicating enhanced uptake of one agent over the other. Quantitative
analysis for all segments showed significant correlation (r = .86, P <
.001) between quantitative regional 201Tl redistribution activity and
1-hour post-rest injection sestamibi activity in individual segments.
Eighteen of these patients were revascularized, and echocardiography was
repeated 20 +/- 16 days later; segments exhibiting significant regional
ventricular dysfunction before revascularization were classified as having
reversible or irreversible dysfunction on the basis of the change in wall
motion and thickening. 201Tl and sestamibi regional activities were similar
in those segments with reversible (72 +/- 11% [percent of peak activity]
versus 75 +/- 9%, respectively, P = NS) as well as irreversible ventricular
dysfunction (51 +/- 11% versus 50 +/- 8%, P = NS). Positive (75% versus 80%
for 201Tl and sestamibi, respectively) and negative (92% versus 96%,
respectively) predictive values for recovery of regional ventricular
dysfunction after revascularization were similar for the two agents.
CONCLUSIONS: In patients with coronary artery disease and left ventricular
dysfunction, quantified sestamibi activity 1 hour after rest injection
parallels redistribution 201Tl activity after a resting injection,
suggesting that uptake and subsequent handling of sestamibi are more
complex than can be explained by a pure flow tracer with no redistribution.
Quantitative analysis of regional activities of both 201Tl and sestamibi
after resting injections can differentiate viable from nonviable
myocardium, and the two agents comparably predict reversibility of
significant regional wall motion abnormalities after revascularization in
such patients to a similar degree.
ARTICLES
Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi
Department of Medicine, Tufts University School of Medicine, Boston, Mass.
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