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Sublingual Isosorbide Dinitrate to Improve Technetium-99m-Teboroxime Perfusion Defect Reversibility

Nuclear Medicine Unit, Department of Clinical Pathophysiology, University of Florence
Division of Cardiology, Careggi Hospital, Florence, Italy

Correspondence: For correspondence and reprints contact: Gianni Bisi, MD, Nuclear Medicine Unit, Department of Clinical Pathophysiology, University of Florence, Viale Morgagni 85, I-50134 Florence, Italy.

ABSTRACT

Previous studies demonstrate perfusion defect reversibility in ²⁰¹Tl reinjection imaging performed after the administration of nitrates. This study tests whether the acute sublingual administration of isosorbide dinitrate (ISDN) could improve the capability of ^99mTc-teboroxime to detect reversibility in exercise-induced perfusion defects. Methods: Ten patients with previous myocardial infarction underwent exercise, redistribution and reinjection ²⁰¹Tl imaging, ^99mTc-teboroxime exercise and rest scans. Following the latter, 5 mg sublingual ISDN were given, ^99mTc-teboroxime was reinjected and images collected. Results: The total defect score/patient in the ²⁰¹Tl images was 10.5 ± 3.1 (mean ± s.d.), decreasing to 7.4 ± 2.7 after redistribution (p < 0.02) and to 4.8 ± 2.1 after reinjection (p < 0.01 versus redistribution). The total defect score in ^99mTc-teboroxime exercise images was 12.7 ± 3.1 (p < 0.05 versus ²⁰¹Tl exercise), decreasing to 7.3 ± 3.3 at rest (p < 0.01 versus exercise, NS versus ²⁰¹Tl redistribution) and to 5.6 ± 2.6 in ISDN images (p < 0.02 versus rest, p < 0.05 versus ²⁰¹Tl redistribution, NS versus reinjection). Of the 44 abnormal segments in ²⁰¹Tl exercise images, the redistribution scan identified 26 defects as reversible and 18 as fixed. After reinjection, 37 defects appeared reversible and only seven fixed (p < 0.005 versus redistribution). Stress-rest ^99mTc-teboroxime classified 33 segments as reversible and 11 as fixed (NS versus both ²⁰¹Tl protocols). After ISDN, the uptake score increased in 19 segments. Therefore, 37 were classified as reversible and seven as fixed defects (p < 0.01 versus ²⁰¹Tl redistribution, NS versus ²⁰¹Tl reinjection). Conclusions: Sublingual ISDN before ^99mTc-teboroxime rest injection seemed to improve the tracer capability of detecting reversibility in exercise-induced perfusion defects.

Key Words: isosorbide dinitrate • technetium-99m-teboroxime • thallium-201 • myocardial viability

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