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The Effect of Nitroglycerin on Myocardial Blood Flow in Various Segments Characterized by Rest-Redistribution Thallium SPECT

¹ Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
² Department of Investigative Radiology, National Cardiovascular Center, Suita, Japan
³ Department of Nuclear Medicine, Hokkaido University School of Medicine, Sapporo, Japan
⁴ Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

The use of nitrates is reported to be effective in viability detection in scintigraphic perfusion imaging. The purpose of the study was to evaluate the effect of nitroglycerin (NTG) on myocardial blood flow (MBF) and coronary vascular resistance (CVR) in various segments characterized by rest-redistribution ²⁰¹Tl SPECT. Methods: Twenty-three patients with coronary artery disease underwent rest-redistribution ²⁰¹Tl SPECT and ¹⁵O-labeled water PET at rest and after NTG spray (0.3 mg). In addition, 11 healthy volunteers were also studied using PET. Results: NTG did not change global MBF in the volunteers or in the patients. In segments with normal ²⁰¹Tl uptake and in those with a severe irreversible ²⁰¹Tl defect, NTG significantly reduced MBF without changing CVR. NTG reduced CVR in segments with a reversible ²⁰¹Tl defect (141 ± 50 to 114 ± 29 mm Hg/[mL/min/g], P = 0.004) and in those with a mild-to-moderate irreversible ²⁰¹Tl defect (165 ± 64 to 149 ± 60 mm Hg/[mL/min/g], P = 0.003), while maintaining MBF. Conclusion: NTG preferentially reduces CVR in the viable myocardium with ischemia. After NTG, tracer uptake in the ischemic myocardium will be relatively increased compared with that in the nonviable and nonischemic myocardium, leading to improvements in viability detection.

Key Words: blood flow • nitroglycerin • perfusion • myocardial infarction

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