OtherCLINICAL INVESTIGATIONS

Low-Dose Dobutamine Electrocardiograph-Gated Myocardial SPECT for Identifying Viable Myocardium: Comparison with Dobutamine Stress Echocardiography and PET

Keiichiro Yoshinaga, Koichi Morita, Satoshi Yamada, Kaoru Komuro, Chietsugu Katoh, Yoshinori Ito, Yuji Kuge, Tetsuro Kohya, Akira Kitabatake and Nagara Tamaki
Journal of Nuclear Medicine June 2001, 42 (6) 838-844;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Segmental evaluation pattern for DSE, DS SPECT, and FDG positron emission tomograms. A = anterior; AA = anterior apex; AI = inferior apex; AS = anteroseptal; I = inferior; L = lateral; P = posterior; S = septal.

  • FIGURE 2.
    FIGURE 2.

    Representative images from 70-y-old man with inferior myocardial infarction. (A) Inferior segment was considered viable on basis of FDG PET findings. (B) Inferior segment had severe hypokinesis in resting gated SPECT image. (C) Dobutamine stress improved wall motion abnormality. ED = end-diastole; ES = end-systole.

  • FIGURE 3.
    FIGURE 3.

    Representative images from 72-y-old woman with anteroseptal myocardial infarction. (A) Anteroseptal segment was considered not viable on basis of FDG PET findings. (B) Anteroseptal segment showed severe hypokinesis on resting gated SPECT image. (C) No improvement in wall motion was observed during dobutamine infusion. ED = end-diastole; ES = end-systole.

Tables

  • TABLE 1

    Clinical Characteristics of the 21 Patients

    Patient no.Age (y)SexMyocardial infarctionCoronary stenosisEjection fraction (%)
    164MInferiorRCA45
    274MInferiorRCA, LAD68
    366MAnteroseptalRCA, LAD38
    464MInferiorRCA, LAD, LCX27
    560MAnteriorLAD47
    670MInferiorRCA49
    766FAnteriorLAD24
    874MInferiorRCA47
    967MAnteriorLAD54
    1070MIschemic cardiomyopathyRCA, LAD, LCX43
    1159MInferiorRCA, LAD, LCX34
    1274MInferiorRCA, LAD55
    1347FInferiorRCA, LAD49
    1474MInferiorRCA, LAD, LCX64
    1565MAnteriorLAD, LCX57
    1666MAnteriorLAD44
    1773FInferiorRCA, LAD, LCX67
    1872FAnteroseptal, inferiorRCA, LAD44
    1949MInferiorRCA39
    2067MAnteroseptal, inferiorRCA, LAD48
    2176FAnteroseptalRCA, LAD, LCX60

    • RCA = right coronary artery; LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery.

  • TABLE 2

    Diagnostic Accuracy of Viability Assessment by Each Method

    MethodSensitivitySpecificityPPVNPV
    DS SPECT76%  (26/34)100%  (21/21)100%  (26/26)72%  (21/29)
    DSE78%  (25/32)94%  (17/18)96%  (25/26)70%  (17/24)
    Rest SPECT85%  (29/34)52%  (11/21)*74%  (29/39)†69%  (11/16)

    • ↵* P < 0.05 vs. DS SPECT.

    • ↵† P < 0.01 vs. DS SPECT.

    • PPV = positive predictive value; NPV = negative predictive value.

  • TABLE 3

    Viability Findings Based on DS SPECT and DSE

    DSEDS SPECT
    ViableNonviableTotal
    Viable22325
    Nonviable42125
    Total262450

    • Concordance rate = 86%; κ = 0.72.

  • TABLE 4

    Viability Findings Based on DS SPECT and Rest SPECT

    Rest SPECTDS SPECT
    ViableNonviableTotal
    Viable231639
    Nonviable31316
    Total262955

    • Concordance rate = 65%; κ = 0.32.

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