| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
CLINICAL INVESTIGATIONS |
Departments of Nuclear Medicine, Cardiovascular Medicine, and Tracer Kinetics, Hokkaido University School of Medicine, Sapporo, Japan
The identification of severely dysfunctional but viable myocardium is of particular importance for the selection of patients with depressed left ventricular function who will benefit from coronary revascularization. Assessment of inotropic reserve with dobutamine has recently been used for this purpose. This study compared the accuracy of low-dose dobutamine stress gated myocardial SPECT (DS SPECT) with the accuracy of dobutamine stress echocardiography (DSE) and resting perfusion SPECT for the identification of viable myocardium in patients with previous myocardial infarction. Methods: Resting and low-dose dobutamine (7.5 µg/kg/min) gated 99mTc-tetrofosmin SPECT and echocardiography and resting 18F-FDG PET were prospectively studied in 23 patients with previous myocardial infarction and severely depressed regional function. Twenty-one of them were successfully studied with each technique. The left ventricular wall was divided into 14 segments to assess wall motion using a 5-point scale. PET viability was defined as FDG uptake 
50% of the maximum uptake in a region with normal wall motion. For DS SPECT and DSE studies, viable myocardium was defined as hypokinetic areas with 1 point improvement in wall motion. For resting perfusion SPECT, viable myocardium was defined as hypokinetic areas with a relative uptake 50% of the maximum uptake. Results: Of a total of 294 segments, 55 had severe resting dyskinesis. Thirty-four segments were identified as viable on FDG PET, and 21 segments were identified as nonviable. Eleven segments were inadequately visualized with DSE, including 5 segments in the apex. Sensitivities (78% vs. 76%) and specificities (94% vs. 100%) were similar for DSE and DS SPECT, with a concordance of 86% (
= 0.72). DS SPECT and perfusion SPECT did not significantly differ with respect to sensitivities (76% vs. 85%, respectively). However, specificity was significantly higher for DS SPECT than for perfusion SPECT (100% vs. 52%, respectively, P < 0.05). Conclusion: This study indicated that DS SPECT correlates well with DSE in the assessment of viability. In addition, gated SPECT can evaluate regional wall motion, even in areas inadequately assessed by echocardiography. DS SPECT may also provide additional information for identifying viable myocardium, which is often overestimated by routine perfusion scans.
Key Words: myocardial viability • dobutamine • emission CT echocardiography • FDG
This article has been cited by other articles:
|
|
 |
|
  A. K. Paul and H. A. Nabi Gated Myocardial Perfusion SPECT: Basic Principles, Technical Aspects, and Clinical Applications J. Nucl. Med. Technol., December 1, 2004; 32(4): 179 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yoshinaga, C. Katoh, R. S.B. Beanlands, K. Noriyasu, K. Komuro, S. Yamada, Y. Kuge, K. Morita, A. Kitabatake, and N. Tamaki Reduced Oxidative Metabolic Response in Dysfunctional Myocardium with Preserved Glucose Metabolism but with Impaired Contractile Reserve J. Nucl. Med., November 1, 2004; 45(11): 1885 - 1891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Go, M. R. Bhatt, and R. C. Hendel The Diagnostic and Prognostic Value of ECG-Gated SPECT Myocardial Perfusion Imaging J. Nucl. Med., May 1, 2004; 45(5): 912 - 921. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Matsunari, J. Taki, and N. Tonami Sequential Strategy Using Multimodality Viability Tests: Does It Work? J. Nucl. Med., June 1, 2002; 43(6): 803 - 805. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| JOURNAL OF NUCLEAR MEDICINE TECHNOLOGY | THE JOURNAL OF NUCLEAR MEDICINE |
