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The Journal of Nuclear Medicine Vol. 40 No. 9 1468-1476
© 1999 by Society of Nuclear Medicine
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BMIPP Imaging to Improve the Value of Sestamibi Scintigraphy for Predicting Functional Outcome in Severe Chronic Ischemic Left Ventricular Dysfunction

Anne-Sophie E. Hambye, André A. Dobbeleir, Ann M. Vervaet, Paul A. Van den Heuvel and Philippe R. Franken

Nuclear Medicine and Cardiology, Middelheim Hospital, Antwerp
Nuclear Medicine, Free University of Brussels (VUB), Brussels, Belgium

Correspondence: For correspondence or reprints contact: Anne-Sophie E. Hambye, MD, PhD, Nuclear Medicine, Middelheim Hospital, Lindendreef 1, 2020 Antwerp, Belgium.

ABSTRACT

Mismatching between beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and perfusion accurately predicts functional outcome after acute myocardial infarction. The current investigation was aimed at evaluating the value of this method to predict the evolution of global function according to the applied treatment in patients with chronic ischemic heart disease. Methods: Twenty patients with infarction and chronic left ventricular dysfunction were studied (median infarction age 12 wk, range 2 wk–15y). Radionuclide angiography, two-dimensional echocardiography and BMIPP and gated sestamibi scintigraphy were performed with the patient at rest before and >6 mo after treatment (revasculanzation in 13 patients and conservative therapy in 7 patients). In 7 patients, radionuclide angiography was repeated after 1 y. Results: On a patient basis, mismatching with BMIPP less than sestamibi was noted in 15 patients at baseline. Of these 15 patients, 11 had significant functional improvement at follow-up versus only 1 of the 5 patients with a matched decreased uptake. Hence, the combined sestamibi/BMIPP was 73% positive and 80% negative in predicting functional outcome, with a global accuracy of 75%. On a segmental basis, using an optimal threshold of uptake defined by receiver operating characteristic curve analysis, sestamibi was only 63% accurate in predicting regional outcome. Adding BMIPP improved the accuracy to 80% (P = 0.001). At follow-up, significant mismatching was still noted in 7 patients in the revascularized group and I in the medically treated group. The mismatch was associated with a further increase in ejection fraction at 1-y follow-up in only the revascularized group. Conclusion: In patients with chronic left ventricular dysfunction after infarction, a mismatching with BMIPP less than sestamibi reliably identifies jeopardized but viable myocardium and predicts functional recovery with an accuracy similar to that reported in the acute and subacute phases of the infarction.

Key Words: myocardial viability • BMIPP • functional recovery • chronic left ventricular dysfunction • ejection fraction






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Copyright © 1999 by the Society of Nuclear Medicine.