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Myocardial Viability Index in Chronic Coronary Artery Disease: Technetium-99m-Methoxy Isobutyl Isonitrile Redistribution

Nuclear Medicine Department, CNR Nuclear Medicine Center and Medical Clinic, University Federico II
National Cancer Institute, Naples, Italy

Correspondence: For correspondence or reprints contact: Simone Maurea, MD, via Raffaele De Cesare 7, 80132 Napoli, Italy.

ABSTRACT

The purpose of this study was to evaluate whether an additional redistribution image after a rest ^99mMIBI injection enhances detection of viable myocardium and predicts functional recovery after coronary revascularization in patients with chronic coronary artery disease (CAD). Methods: Thirty-one patients (29 men, mean age 55 ± 10 yr) with proven CAD and left ventricular (LV) dysfunction (ejection fraction 39% ± 9%) underwent resting ^99mTc-MIBI tomography with initial (1 hr) and delayed (5 hr) images. Within 1 wk of MIBI imaging, all patients underwent rest-redistribution ²⁰¹Tl imaging. Eight patients also underwent two-dimensional echocardiography before and 5 ± 3 mo after coronary revascularization. Results: On the initial ^99mTc-MIBI images, 302 myocardial segments were normal, 183 showed moderate and 197 severe reduction of tracer uptake. Of these 197 segments, 47 (24%) demonstrated increased tracer uptake (10% versus initial) on delayed images (from 43% ± 8% to 60% ± 8%, p<0.001) and were considered as showing ^99mTc-MIBI redistribution. Theses 47 segments were observed in 20 (65%) patients in wom ²⁰¹Tl images detedted viable myocardium in the same segments. Tn the eight patients studied before and after revascularization, while 96% of segments without ^99mTc-MIBI redistribution did not show functional recovery. Conclusion: Resting ^99mTc-MIBI redistribution frequently occurs in patients with chronic CAD. Acquisition of ^99mTc-MIBI redistribution imagesen hances detection of viable myocardium and predicts functional recovery after revascularization.

Key Words: technetium-99m-sestamibi • left ventricular dysfunction • functional recovery • thallium-201

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