Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?
Yıl: 2020 Cilt: 24 Sayı: 2 Sayfa Aralığı: 83 - 91 Metin Dili: İngilizce DOI: 10.14744/AnatolJCardiol.2020.99148 İndeks Tarihi: 11-11-2020
Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?
Öz: Objective: Early identification of viable myocardium in ischemic cardiomyopathy (ICM) patients is essential for early intervention and better clinical outcome. 99mTechnetium (99mTc) sestamibi gated myocardial perfusion imaging (gMPI) is a well-established technique for myocardial viability evaluation. Detection of potentially viable segments is a predictor of hibernating myocardium. ICM patients with hibernation have a better prognosis after revascularization. We used a novel infusion technique to determine better viability detection preoperatively in challenging situations. Like thallium, does prolonged availability of sestamibi in circulation with additional low dose dobutamine steady infusion (DS Inf) facilitate improved myocardial viability?Methods: A total of 58 ICM patients with infarct and left ventricular ejection fraction (LVEF) <45% underwent 99mTc sestamibi bolus injection followed by slow intravenous infusion single-photon emission computed tomography (SPECT) using a 2 day protocol. After acquiring the second set of 99mTc sestamibi infusion images, a third SPECT gMPI was performed during DS Inf.Results: A 17-segment myocardial model was used; 52 of 58 patients (548/986 segments) demonstrated perfusion defects (nonviable myocardium) on bolus study. Only 24 patients demonstrated viable segments by standard bolus imaging protocol. The slow MIBI infusion study demonstrated 158 viable segments (12 ICM patients), while combined infusion (99mTc sestamibi+DS Inf) exhibited an additional 6 patients with improved myocardial viability. Thus, 18 high risk patients benefited by this novel infusion technique to demonstrate viable myocardium on SPECT. There was a significantly higher sensitivity (p=0.05) and positive predictive value (p=0.01) in viability identification with the combined DS Inf technique. In dysfunctional segments, the rate of concordance for detecting viability between infusion and bolus techniques was 65%. Paired t test showed statistically significant improvement in viability detection with combined infusion compared to the bolus study (p=0.001).Conclusion: This novel infusion technique was shown to be feasible and incremental in viability detection in ICM patients with severe left ventricular dysfunction. It is a robust tool to guide revascularization, in high risk ICM patients. This study also showed that patients with large transmural MI demonstrated no significant improvement in myocardial perfusion status using either protocol.
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- 1. Erthal F, Wiefels C, Promislow S, Kandolin R, Stadnick, E, Mielniczuk L, et al. Myocardial Viability: From PARR-2 to IMAGE HF - Current Evidence and Future Directions. Int J Cardiovasc Sci 2019; 32: 70-83.
- 2. Hwang SJ, Melenovsky V, Borlaug BA. Implications of coronary artery disease in heart failure with preserved ejection fraction. J Am Coll Cardiol 2014; 63: 2817-27.
- 3. O'Meara E, Mielniczuk LM, Wells GA, deKemp RA, Klein R, Coyle D, et al.; IMAGE HF investigators. Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) IMAGE HF Project I-A: study protocol for a randomized controlled trial. Trials 2013; 14: 218.
- 4. Worsley DF, Fung AY, Jue J, Burns RJ. Identification of viable myocardium with technetium-99m-MIBI infusion. J Nucl Med 1995; 36: 1037-9.
- 5. Giordano A, Trani C, Lombardo A, Maseri A. Detection of hibernated myocardium using intracoronary technetium-99m-sestamibi. Q J Nucl Med 1997; 41: 46-50.
- 6. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1995; 26: 639-47.
- 7. Soman P, Udelson JE. Assessment of myocardial viability by nuclear imaging in coronary heart disease. Official reprint from UpToDate. www.uptodate.com ©2020 Up-to-date, Inc. and/or its affiliates, Retrieved and last updated Dec 27, 2017.
- 8. Suzuki K, Hirano Y, Yamada H, Murata M, Daimon M, Takeuchi M, et al. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018; 16: 105-29.
- 9. Cuocolo A, Maurea S, Pace L, Nicolai E, Nappi A, Imbriaco M, et al. Resting technetium-99m methoxyisobutylisonitrile cardiac imaging in chronic coronary artery disease: comparison with rest-redistribution thallium-201 scintigraphy. Eur J Nucl Med 1993; 20: 1186-92.
- 10. Piérard LA. Comparison of approaches in the assessment of myocardial viability and follow-up of PTCA/CABG. The role of echocardiography. Int J Card Imaging 1993; 9 Suppl 1: 11-7.
- 11. Dilsizian V, Arrighi JA, Diodati JG, Quyyumi AA, Alavi K, Bacharach SL, et al. Myocardial viability in patients with chronic coronary artery disease. Comparison of 99mTc-sestamibi with thallium reinjection and [18F]fluorodeoxyglucose. Circulation 1994; 89: 578-87.
- 12. Altehoefer C, vom Dahl J, Biedermann M, Uebis R, Beilin I, Sheehan F, et al. Significance of defect severity in technetium-99m-MIBI SPECT at rest to assess myocardial viability: comparison with fluorine- 18-FDG PET. J Nucl Med 1994; 35: 569-74.
- 13. Miron SD, Finkelhor R, Bahler R, Sodee DB, Bellon EM. Use of Tc- 99m sestamibi infusion for detection of hibernating myocardium. A preliminary report. Clin Nucl Med 1995; 20: 440-5.
- 14. Akpinar AT, Baran I, Gullulu S, Gunes N, Saltan Y, Alper E, et al. Contribution of 99mTc-sestamibi infusion SPECT to the characterization of fixed perfusion defects. Ann Nucl Med 2006; 20: 471-5.
- 15. Leoncini M, Marcucci G, Sciagrà R, Frascarelli F, Simonetti I, Bini L, et al. Prediction of functional recovery in patients with chronic coronary artery disease and left ventricular dysfunction combining the evaluation of myocardial perfusion and of contractile reserve using nitrate-enhanced technetium-99m sestamibi gated singlephoton emission computed tomography and dobutamine stress. Am J Cardiol 2001; 87: 1346-50.
- 16. Zafrir N, Arditi A, Ben-Gal T, Solodky A, Hassid Y, Sulkes J, et al. Additive value of low-dose dobutamine to technetium-99m sestamibigated single-photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft. Clin Cardiol 2003; 26: 530-5.
- 17. Yoshinaga K, Morita K, Yamada S, Komuro K, Katoh C, Ito Y, et al. Low-dose dobutamine electrocardiograph-gated myocardial SPECT for identifying viable myocardium: comparison with dobutamine stress echocardiography and PET. J Nucl Med 2001; 42: 838- 44.
- 18. Bax JJ, Poldermans D, Elhendy A, Boersma E, Rahimtoola SH. Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium. Curr Probl Cardiol 2001; 26: 147-86.
- 19. DeVore A, Hellkamp A, Thomas LE, Sharma PP, Albert NM, Butler J, et al. Improvement in LVEF in Outpatients With Heart Failure With Reduced Ejection Fraction: Data From CHAMP-HF. Circulation 2019; 140 (Suppl_1): A15139.
| APA | SUBRAMANYAM P, PALANISWAMY S (2020). Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. , 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| Chicago | SUBRAMANYAM Padma,PALANISWAMY Shanmuga Sundaram Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. (2020): 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| MLA | SUBRAMANYAM Padma,PALANISWAMY Shanmuga Sundaram Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. , 2020, ss.83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| AMA | SUBRAMANYAM P,PALANISWAMY S Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. . 2020; 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| Vancouver | SUBRAMANYAM P,PALANISWAMY S Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. . 2020; 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| IEEE | SUBRAMANYAM P,PALANISWAMY S "Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?." , ss.83 - 91, 2020. 10.14744/AnatolJCardiol.2020.99148 |
| ISNAD | SUBRAMANYAM, Padma - PALANISWAMY, Shanmuga Sundaram. "Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?". (2020), 83-91. https://doi.org/10.14744/AnatolJCardiol.2020.99148 |
| APA | SUBRAMANYAM P, PALANISWAMY S (2020). Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. The Anatolian Journal of Cardiology, 24(2), 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| Chicago | SUBRAMANYAM Padma,PALANISWAMY Shanmuga Sundaram Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. The Anatolian Journal of Cardiology 24, no.2 (2020): 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| MLA | SUBRAMANYAM Padma,PALANISWAMY Shanmuga Sundaram Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. The Anatolian Journal of Cardiology, vol.24, no.2, 2020, ss.83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| AMA | SUBRAMANYAM P,PALANISWAMY S Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. The Anatolian Journal of Cardiology. 2020; 24(2): 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| Vancouver | SUBRAMANYAM P,PALANISWAMY S Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?. The Anatolian Journal of Cardiology. 2020; 24(2): 83 - 91. 10.14744/AnatolJCardiol.2020.99148 |
| IEEE | SUBRAMANYAM P,PALANISWAMY S "Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?." The Anatolian Journal of Cardiology, 24, ss.83 - 91, 2020. 10.14744/AnatolJCardiol.2020.99148 |
| ISNAD | SUBRAMANYAM, Padma - PALANISWAMY, Shanmuga Sundaram. "Does myocardial viability detection improve using a novel combined 99mTc sestamibi infusion and low dose dobutamine infusion in high risk ischemic cardiomyopathy patients?". The Anatolian Journal of Cardiology 24/2 (2020), 83-91. https://doi.org/10.14744/AnatolJCardiol.2020.99148 |
