(Circulation. 2000;101:1465.)
© 2000 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease
From the Cardiovascular Division, University of Virginia Health System, Charlottesville, Va (G.A.B.), and the Cardiology Division, Yale University, New Haven, Conn (B.L.Z.).
Key Words: imaging • coronary disease • thallium-201 • technetium-99m-sestamibi
In the past decade, significant advances have been made in the ability to image the heart with radionuclide tracers under stress and resting conditions in patients with suspected or known coronary artery disease (CAD) for the detection of ischemia, determination of prognosis, assessment of myocardial viability, preoperative risk assessment for patients undergoing noncardiac surgery, and evaluation of the efficacy of revascularization in patients undergoing coronary artery bypass surgery or an interventional procedure.1
For many years, planar imaging and SPECT with 201Tl constituted the only scintigraphic techniques available for detecting CAD and assessing prognosis in patients undergoing stress perfusion imaging. The major limitation of 201Tl scintigraphy is the high false-positive rate observed in many laboratories, which is attributed predominantly to image attenuation artifacts and variants of normal that are interpreted as defects consequent to a significant coronary artery stenosis. Although quantification of 201Tl images improves specificity, the false-positive rate remains problematic, particularly in women and in obese patients. Breast attenuation artifacts in women are sometimes difficult to distinguish from perfusion abnormalities secondary to inducible ischemia or myocardial scar.
In recent years, new 99mTc-labeled perfusion
agents have been introduced into clinical practice to enhance the
specificity of SPECT and to provide additional information regarding
regional and global left ventricular systolic
function via ECG gating of images. It was immediately apparent that the
quality of images obtained with these new
99mTc-labeled radionuclides was superior to that
of images obtained with 201Tl because of the more
favorable physical characteristics of 99mTc
imaging with a
This article has been cited by other articles:
 |
|
 |
|
  H. S. Hecht Coronary Artery Calcium: The Cup Is 96% Full J. Am. Coll. Cardiol. Img., October 1, 2009; 2(10): 1184 - 1186. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Uebleis, A. Becker, I. Griesshammer, P. Cumming, C. Becker, M. Schmidt, P. Bartenstein, and M. Hacker Stable Coronary Artery Disease: Prognostic Value of Myocardial Perfusion SPECT in Relation to Coronary Calcium Scoring--Long-term Follow-up Radiology, September 1, 2009; 252(3): 682 - 690. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Doesch, A. Seeger, J. Doering, C. Herdeg, C. Burgstahler, C. D. Claussen, M. Gawaz, S. Miller, and A. E. May Risk Stratification by Adenosine Stress Cardiac Magnetic Resonance in Patients With Coronary Artery Stenoses of Intermediate Angiographic Severity J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 424 - 433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Chua The evolving role of molecular imaging for coronary artery disease: where do we stand today? Heart Asia, March 6, 2009; 2009(2): 1 - 5. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A.L. Tonino, B. De Bruyne, N. H.J. Pijls, U. Siebert, F. Ikeno, M. van `t Veer, V. Klauss, G. Manoharan, T. Engstrom, K. G. Oldroyd, et al. Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention N. Engl. J. Med., January 15, 2009; 360(3): 213 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Hoeks and D. Poldermans CHAPTER 34 Non-cardiac Surgery in Cardiac Patients ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Schwitter, C. M. Wacker, A. C. van Rossum, M. Lombardi, N. Al-Saadi, H. Ahlstrom, T. Dill, H. B.W. Larsson, S. D. Flamm, M. Marquardt, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial Eur. Heart J., February 2, 2008; 29(4): 480 - 489. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. D'Amico, J. W. Denham, J. Crook, M.-H. Chen, S. Z. Goldhaber, D. S. Lamb, D. Joseph, K.-H. Tai, S. Malone, C. Ludgate, et al. Influence of Androgen Suppression Therapy for Prostate Cancer on the Frequency and Timing of Fatal Myocardial Infarctions J. Clin. Oncol., June 10, 2007; 25(17): 2420 - 2425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. H.J. Pijls, P. van Schaardenburgh, G. Manoharan, E. Boersma, J.-W. Bech, M. van't Veer, F. Bar, J. Hoorntje, J. Koolen, W. Wijns, et al. Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis: 5-Year Follow-Up of the DEFER Study J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2105 - 2111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Jahnke, E. Nagel, R. Gebker, T. Kokocinski, S. Kelle, R. Manka, E. Fleck, and I. Paetsch Prognostic Value of Cardiac Magnetic Resonance Stress Tests: Adenosine Stress Perfusion and Dobutamine Stress Wall Motion Imaging Circulation, April 3, 2007; 115(13): 1769 - 1776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yoshinaga, B. J.W. Chow, K. Williams, L. Chen, R. A. deKemp, L. Garrard, A. Lok-Tin Szeto, M. Aung, R. A. Davies, T. D. Ruddy, et al. What is the Prognostic Value of Myocardial Perfusion Imaging Using Rubidium-82 Positron Emission Tomography? J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1029 - 1039. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Elhendy, A. F.L. Schinkel, R. T. van Domburg, J. J. Bax, R. Valkema, E. Biagini, and D. Poldermans Prognostic Stratification of Obese Patients by Stress 99mTc-Tetrofosmin Myocardial Perfusion Imaging J. Nucl. Med., August 1, 2006; 47(8): 1302 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mandapaka, R. D'Agostino Jr, and W. G. Hundley Does Late Gadolinium Enhancement Predict Cardiac Events in Patients With Ischemic Cardiomyopathy? Circulation, June 13, 2006; 113(23): 2676 - 2678. [Full Text] [PDF]
|
|
|
|
|
|
J. Rieber, A. Huber, I. Erhard, S. Mueller, M. Schweyer, A. Koenig, T. M. Schiele, K. Theisen, U. Siebert, S. O. Schoenberg, et al. Cardiac magnetic resonance perfusion imaging for the functional assessment of coronary artery disease: a comparison with coronary angiography and fractional flow reserve Eur. Heart J., June 2, 2006; 27(12): 1465 - 1471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L.M.A. Beeres, J. J. Bax, P. Dibbets, M. P.M. Stokkel, K. Zeppenfeld, W. E. Fibbe, E. E. van der Wall, M. J. Schalij, and D. E. Atsma Effect of Intramyocardial Injection of Autologous Bone Marrow-Derived Mononuclear Cells on Perfusion, Function, and Viability in Patients with Drug-Refractory Chronic Ischemia J. Nucl. Med., April 1, 2006; 47(4): 574 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Elhendy, A. Huurman, A. F.L. Schinkel, J. J. Bax, R. T. van Domburg, R. Valkema, E. Biagini, and D. Poldermans Association of Ischemia on Stress99mTc-Tetrofosmin Myocardial Perfusion Imaging with All-Cause Mortality in Patients with Diabetes Mellitus J. Nucl. Med., October 1, 2005; 46(10): 1589 - 1595. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Vakhtangandze, D O Hall, F V Zananiri, and M R Rees The effect of Butterworth and Metz reconstruction filters on volume and ejection fraction calculations with 99Tcm gated myocardial SPECT Br. J. Radiol., August 1, 2005; 78(932): 733 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Liao, W. T. Smith IV, R. H. Tuttle, L. K. Shaw, R. E. Coleman, and S. Borges-Neto Prediction of Death and Nonfatal Myocardial Infarction in High-Risk Patients: A Comparison Between the Duke Treadmill Score, Peak Exercise Radionuclide Angiography, and SPECT Perfusion Imaging J. Nucl. Med., January 1, 2005; 46(1): 5 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F.L. Schinkel, A. Elhendy, E. Biagini, R. T. van Domburg, R. Valkema, V. Rizello, C. Pedone, M. Simoons, J. J. Bax, and D. Poldermans Prognostic Stratification Using Dobutamine Stress 99mTc-Tetrofosmin Myocardial Perfusion SPECT in Elderly Patients Unable to Perform Exercise Testing J. Nucl. Med., January 1, 2005; 46(1): 12 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. H J Pijls Optimum guidance of complex PCI by coronary pressure measurement Heart, September 1, 2004; 90(9): 1085 - 1093. [Full Text] [PDF]
|
|
|
|
|
|
I. Paetsch, C. Jahnke, A. Wahl, R. Gebker, M. Neuss, E. Fleck, and E. Nagel Comparison of Dobutamine Stress Magnetic Resonance, Adenosine Stress Magnetic Resonance, and Adenosine Stress Magnetic Resonance Perfusion Circulation, August 17, 2004; 110(7): 835 - 842. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nasir, R. F. Redberg, M. J. Budoff, E. Hui, W. S. Post, and R. S. Blumenthal Utility of Stress Testing and Coronary Calcification Measurement for Detection of Coronary Artery Disease in Women Arch Intern Med, August 9, 2004; 164(15): 1610 - 1620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Tschoepe and W. Burchert Non-invasive imaging for coronary artery disease in diabetes The British Journal of Diabetes & Vascular Disease, July 1, 2004; 4(4): 245 - 250. [Abstract] [PDF]
|
|
|
|
|
|
S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Beller and D. D. Watson Risk stratification using stress myocardial perfusion imaging: don't neglect the value of clinical variables J. Am. Coll. Cardiol., January 21, 2004; 43(2): 209 - 212. [Full Text] [PDF]
|
|
|
|
|
|
G. S. Thomas, M. I. Miyamoto, A. P. Morello III, H. Majmundar, J. J. Thomas, C. H. Sampson, R. Hachamovitch, and L. J. Shaw Technetium99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting: The Nuclear Utility in the Community (NUC) Study J. Am. Coll. Cardiol., January 21, 2004; 43(2): 213 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Orlic, J. M. Hill, and A. E. Arai Stem Cells for Myocardial Regeneration Circ. Res., December 13, 2002; 91(12): 1092 - 1102. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. L. Schinkel, A. Elhendy, R. T. van Domburg, J. J. Bax, R. Valkema, J. R. T. C. Roelandt, and D. Poldermans Long-term Prognostic Value of Dobutamine Stress 99mTc-Sestamibi SPECT: Single-Center Experience with 8-year Follow-up Radiology, December 1, 2002; 225(3): 701 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F.L. Schinkel, A. Elhendy, R. T. van Domburg, J. J. Bax, J. R.T.C. Roelandt, and D. Poldermans Prognostic Value of Dobutamine-Atropine Stress 99mTc-Tetrofosmin Myocardial Perfusion SPECT in Patients with Known or Suspected Coronary Artery Disease J. Nucl. Med., June 1, 2002; 43(6): 767 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. J. Chamuleau, R. A. Tio, C. C. de Cock, E. D. de Muinck, N. H. J. Pijls, B. L. F. van Eck-Smit, K. T. Koch, M. Meuwissen, M. G. W. Dijkgraaf, A. de Jong, et al. Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease J. Am. Coll. Cardiol., March 6, 2002; 39(5): 852 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Kuvin, A. R. Patel, K. A. Sliney, N. G. Pandian, W. M. Rand, J. E. Udelson, and R. H. Karas Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1843 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G J W Bech, H Droste, N H J Pijls, B De Bruyne, J J R M Bonnier, H R Michels, K H Peels, and J J Koolen Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease Heart, November 1, 2001; 86(5): 547 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G.A. Beller The role of myocardial perfusion imaging in patient assessment after acute myocardial infarction Eur. Heart J. Suppl., September 1, 2001; 3(suppl_F): F8 - F10. [Abstract] [PDF]
|
|
|
|
|
|
G. J. W. Bech, B. De Bruyne, N. H.J. Pijls, E. D. de Muinck, J. C.A. Hoorntje, J. Escaned, P. R. Stella, E. Boersma, J. Bartunek, J. J. Koolen, et al. Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis : A Randomized Trial Circulation, June 19, 2001; 103(24): 2928 - 2934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Levin, L. Parker, C. M. Intenzo, and J. H. Sunshine Recent Rapid Increase in Utilization of Radionuclide Myocardial Perfusion Imaging and Related Procedures: 1996-1998 Practice Patterns Radiology, January 1, 2002; 222(1): 144 - 148. [Abstract] [Full Text] [PDF]
|
|