(Circulation. 1995;91:313-319.)
© 1995 American Heart Association, Inc.
Articles |
Myocardial Perfusion Imaging With 99mTc Tetrofosmin
Comparison to 201Tl Imaging and Coronary Angiography in a Phase III Multicenter Trial
Background Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies.
Methods and Results Two hundred fifty-two patients with
suspected coronary artery disease were enrolled in 10 centers in the
United States and Europe. All patients underwent exercise and rest
myocardial perfusion imaging with 99mTc-tetrofosmin using
two separate injections of the radiotracer 4 hours apart on the same
day. Planar images were obtained in three standard views 15 to 60
minutes after radiotracer injection. Patients also underwent standard
exercise and redistribution planar 201Tl imaging within 2
weeks of tetrofosmin imaging. In addition, 58 healthy subjects with low
likelihood of coronary artery disease underwent exercise and rest
tetrofosmin imaging. Coronary angiograms were available in 181 patients
with suspected coronary artery disease. All radionuclide images were
processed in the central core laboratory and interpreted blindly by a
panel of four experienced readers. 201Tl images and
tetrofosmin images were read separately. Discrepancies were resolved by
consensus. The workload, peak heart rate, and double products were
comparable during exercise for both imaging agents. Technically
acceptable paired 201Tl and tetrofosmin images were
available in 224 of 252 patients. Tetrofosmin images were generally of
good quality, with low extracardiac activity, and easy to interpret.
Patients were categorized as showing normal, ischemia, infarction, or
mixture with each imaging modality. Precise concordance for each of
these categories was 59.4% (
=0.44; 95% CI, 0.35 to 0.53). When
patients were categorized as normal or abnormal, the concordance was
80.4% (=0.55; 95% CI, 0.43 to 0.67). When each of five anatomic
territories (septal, anterior, inferior, lateral, and apical) was
categorized as normal versus abnormal, the concordance varied from 81%
to 90%. When similar comparison was made for the specific category of
abnormality, the concordance was 64% to 84%. When coronary
angiography was used as the criterion, the sensitivity and positive and
negative predictive accuracy of tetrofosmin and 201Tl were
comparable. The normalcy rate of tetrofosmin images in the healthy
subjects with low likelihood of coronary artery disease was 97%.
Conclusions 99mTc tetrofosmin is a new myocardial imaging agent with favorable imaging characteristics with results comparable to those of 201Tl.
Key Words: tetrofosmin • imaging
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