Skip to main content
SpringerLink
Log in

Comparison of the prognostic value of SPECT after nitrate administration and metabolic imaging by PET in patients with ischaemic left ventricular dysfunction

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We compared the prognostic value of 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) after nitrate administration and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with ischaemic left ventricular (LV) dysfunction.

Methods

Eighty-nine patients with previous myocardial infarction and LV dysfunction (LV ejection fraction 33 ± 10%) underwent 99mTc-tetrofosmin SPECT under control conditions (baseline) and after sublingual administration of 10 mg of isosorbide dinitrate (nitrate). Within 1 week, all patients underwent PET imaging with 18F-FDG. Four patients were excluded because of inadequate FDG uptake caused by severe diabetes. Follow-up data were obtained by phone contact with patients and by review of hospital or physicians’ records. Cardiac death, myocardial infarction and late revascularisation for unstable angina were considered as events. Follow-up data were not available in three patients. Follow-up was 96% complete at a mean period of 29 ± 19 months.

Results

At baseline SPECT, 59 (72%) patients had evidence of viable myocardium, while 23 did not. Of these latter patients, 12 (52%) demonstrated viable myocardium after nitrate and 13 (56%) had preserved metabolic activity. Cardiac events (cardiac death, myocardial infarction and late revascularisation for unstable angina) occurred in 24 (29%) patients. Event-free survival was similar in patients with and patients without viable myocardium at baseline SPECT (p = 0.8). In contrast, event-free survival was lower in patients with viable myocardium at nitrate SPECT and PET compared to those without viable myocardium (both p<0.05).

Conclusion

In patients with ischaemic LV dysfunction, the prognostic value of SPECT imaging after nitrate is comparable to that of PET metabolic imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Patterson RE, Pilcher WC. Assessing myocardial viability to help select patients for revascularization to improve left ventricular dysfunction due to coronary artery disease. Semin Thorac Cardiovasc Surg 1995;7:214–26.

    PubMed  CAS  Google Scholar 

  2. Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002;39:1151–8.

    Article  PubMed  Google Scholar 

  3. Travin MI, Bergmann SR. Assessment of myocardial viability. Semin Nucl Med 2005;35:2–16.

    Article  PubMed  Google Scholar 

  4. He ZX, Yang MF, Liu XJ, Shi RF, Gao RL, Hu SS, et al. Association of myocardial viability on nitrate-augmented technetium-99m hexakis-2-methoxylisobutyl isonitrile myocardial tomography and intermediate-term outcome in patients with prior myocardial infarction and left ventricular dysfunction. Am J Cardiol 2003;92:696–9.

    Article  PubMed  Google Scholar 

  5. He W, Acampa W, Mainolfi C, Menna F, Sorrentino AR, Petretta M, et al. Tc-99m tetrofosmin tomography after nitrate administration in patients with ischemic left ventricular dysfunction: relation to metabolic imaging by PET. J Nucl Cardiol 2003;10:599–606.

    Article  PubMed  Google Scholar 

  6. Cuocolo A, Petretta M, Nicolai E, Pace L, Bonaduce D, Salvatore M, et al. Successful coronary revascularization improves prognosis in patients with previous myocardial infarction and evidence of viable myocardium at thallium-201 imaging. Eur J Nucl Med 1998;25:60–8.

    Article  PubMed  CAS  Google Scholar 

  7. Acampa W, Cuocolo A, Petretta M, Bruno A, Castellani M, Finzi A, et al. Tetrofosmin imaging in the detection of myocardial viability in patients with previous myocardial infarction: comparison with sestamibi and Tl-201 scintigraphy. J Nucl Cardiol 2002;9:33–40.

    Article  PubMed  Google Scholar 

  8. Bonow RO, Dilsizian V, Cuocolo A, Bacharach S. Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose. Circulation 1991;83:26–37.

    PubMed  CAS  Google Scholar 

  9. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37–46.

    Article  Google Scholar 

  10. Fleiss JL. Statistical methods for rates and proportions, 2nd ed. New York, NY: Wesley and Sons; 1981, p. 217–225.

    Google Scholar 

  11. Altehoefer C, Kaiser HJ, Dorr R, Feinendegen C, Beilin I, Uebis R, et al. Fluorine-18 deoxyglucose PET for assessment of viable myocardium in perfusion defects in 99mTc-MIBI SPET: a comparative study in patients with coronary artery disease. Eur J Nucl Med 1992;19:334–342.

    Article  PubMed  CAS  Google Scholar 

  12. Dilsizian V, Arrighi JA, Diodati JG, Quyyumi AA, Alavi K, Bacharach SL, et al. Myocardial viability in patients with chronic coronary artery disease. Comparison of 99mTc-sestamibi with thallium reinjection and [18F]fluorodeoxyglucose. Circulation 1994;89:578–87.

    PubMed  CAS  Google Scholar 

  13. Sciagrà R, Pellegri M, Pupi A, Bolognese L, Bisi G, Carnovale V, et al. Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 2000;36:739–45.

    Article  PubMed  Google Scholar 

  14. Desideri A, Cortigiani L, Christen AI, Coscarelli S, Gregori D, Zanco P, et al. The extent of perfusion-F18-fluorodeoxyglucose positron emission tomography mismatch determines mortality in medically treated patients with chronic ischemic left ventricular dysfunction. J Am Coll Cardiol 2005;46:1264–9.

    Article  PubMed  Google Scholar 

  15. Siebelink HM, Blanksma PK, Crijns HJ, Bax JJ, van Boven AJ, Kingma T, et al. No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management: a prospective, randomized comparison of patients with suspicion of jeopardized myocardium. J Am Coll Cardiol 2001;37:81–8.

    Article  PubMed  CAS  Google Scholar 

  16. Kaul S. Response of dysfunctional myocardium to dobutamine. The eyes see what the mind knows. J Am Coll Cardiol 1996;27:1608–11.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages of the National Council of Research, University Federico II, Naples, Italy

    Anna Rita Sorrentino, Wanda Acampa, Ciro Mainolfi, Marco Salvatore & Alberto Cuocolo

  2. Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy

    Mario Petretta

Authors
  1. Anna Rita Sorrentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wanda Acampa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Petretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ciro Mainolfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Salvatore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Cuocolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Cuocolo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sorrentino, A.R., Acampa, W., Petretta, M. et al. Comparison of the prognostic value of SPECT after nitrate administration and metabolic imaging by PET in patients with ischaemic left ventricular dysfunction. Eur J Nucl Med Mol Imaging 34, 558–562 (2007). https://doi.org/10.1007/s00259-006-0304-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-006-0304-2

Keywords

Search

Navigation