Combined exercise radionuclide angiocardiography and single photon emission computed tomography perfusion studies for assessment of coronary artery disease

doi:10.1016/S0001-2998(05)80042-X

Seminars in Nuclear Medicine

Volume 21, Issue 3, July 1991, Pages 223-229

https://doi.org/10.1016/S0001-2998(05)80042-X Get rights and content

Although there is widespread use of exercise thallium 201 scintigraphy and radionuclide angiocardiography in patients with coronary artery disease (CAD), little is known about the independence, concordance, or relative importance of these studies in the diagnosis, prognosis, and assessment of the outcome of therapy. The use of both tests in the same patient has been impractical because of the logistic considerations imposed by two exercise tests on separate days and excessive radiation exposure. New technetium 99m-labeled radiopharmaceuticals with high myocardial extraction now permit the simultaneous assessment of myocardial perfusion (single photon emission computed tomography [SPECT]) and ventricular function (radionuclide angiocardiography [RNA]) during treadmill exercise (exercise tolerance test [ETT]). The ability to perform all three tests during a single exercise session offers a very attractive technique to evaluate patients with CAD. The investigators studied 86 patients with chronic CAD using the same-day perfusion and function protocol combined with treadmill exercise. The results demonstrate good concordance between myocardial perfusion and ventricular function as indicated by a significant correlation between tomographic perfusion defect size and ejection fraction (P<.0001, R=0.75 at rest and P<.0001, R=0.76 during exercise). Stepwise logistic regression was used to model ETT, RNA, and SPECT variables against the presence of one or more 60% stenoses by quantitative angiography, an end point present in 47 patients. Univariable analysis showed all three tests (ETT, RNA, and SPECT) to be significant predictors of the end points (χ²=5.1, P<.05; χ²=12.5, P<.001; and χ²=16.1, P<.001, respectively). Multivariable analysis demonstrated that SPECT provided more diagnostic information than ETT and RNA (χ²=16.1, P<.001). However, RNA contributed independent information (χ²=7.1, P<.05), and maximal diagnostic power (χ²=23.2) requires assessment of cardiac function and myocardial perfusion.

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Novel Approach for <sup>99m</sup>Tc-Labeling of Red Blood Cells: Evaluation of <sup>99m</sup>Tc-4SAboroxime as a Blood Pool Imaging Agent
2017, Bioconjugate Chemistry
Angiography with radiolabeled red blood cells (RBCs) plays an important role in diagnosis and prognosis in vascular diseases. Both in vitro and in vivo methods have been developed for ^99mTc-labeling of RBCs. However, these methods are complicated and lack reproducibility. Therefore, it is highly desirable to develop an alternative method for routine ^99mTc-labeling of RBCs. In this report, we present a novel approach for ^99mTc-labeling of RBCs. We prepared a new ^99mTc(III) radiotracer [^99mTcCl(CDO)(CDOH)₂B-4AS] (^99mTc-4ASboroxime: 4AS-B(OH)₂ = 4-aminosulfonylphenyl)boronic acid, and CDOH₂ = cyclohexanedione dioxime) in >95% radiochemical purity. Imaging and biodistribution studies were performed in Sprague–Dawley (SD) rats. It was found that the blood radioactivity was ∼6.0%ID/g (∼90% injected dose for 200–225 g SD rats) for ^99mTc-4ASboroxime with low uptake in the myocardium, kidneys, liver, lungs, and muscle, most likely due to lack of leakage of ^99mTc-labeled RBCs from the intravascular space. The blood radioactivity was almost unchanged over the 2 h period, suggesting that the binding of ^99mTc-4ASboroxime to blood components (cells, proteins, and plasma) is stable. The results from γ-counting of the isolated blood components showed that ^99mTc-4ASboroxime had >95% of blood radioactivity binding to RBCs, ∼1% to albumin, and ∼3% remaining free in blood plasma, demonstrating its RBC-specificity. The results from imaging studies in SD rats indicated that ^99mTc-4ASboroxime is predominantly distributed in the blood pool. Main blood vessels were well delineated in the head/neck and abdominal regions. This statement was further substantiated by the results from imaging studies in pigs. ^99mTc-4ASboroxime is an excellent blood pool agent with the potential for diagnosis and prognosis of vascular diseases.
Short exercise-rest versus long myocardial perfusion gated SPECT protocols in patients with ischemic cardiomyopathy
2010, Revista Espanola de Medicina Nuclear
Analizar la función sistólica ventricular izquierda y la perfusión miocárdica entre los protocolos corto esfuerzo reposo en un solo día y largo en 2 días de la gated-SPECT (Single Photon Emision Computed Tomography) de perfusión miocárdica en pacientes con miocardiopatía isquémica.
Estudio prospectivo de 40 pacientes (59,6±8,9 años, 3 mujeres) con miocardiopatía isquémica (fracción de eyección (FE) ventricular izquierda ≤40%) estudiados mediante gated-SPECT. Entre 5–10 días después de realizar el protocolo corto esfuerzo reposo (gated-SPECT-1) los pacientes fueron recitados para un segundo estudio de reposo (gated-SPECT-2) para comparar los resultados de la FE y de las diferencias de la suma de puntuación de perfusión en reposo (ΔSPR=SPR1–SPR2) y de la suma de puntuación de perfusión diferencial (ΔSPD=SPD1–SPD2) entre ambos protocolos.
En 26 pacientes (65%) la FE de la gated-SPECT-2 fue superior (37 vs 34%, p=0,008) a la de la gated-SPECT-1 y en 11 pacientes (27,5%) el incremento fue ≥5%. No hubo diferencias clínicas ni coronariográficas significativas entre los pacientes con y sin aumento de la fracción de eyección ≥5%. En el análisis múltivariante ΔSPR (IC95%: −1,1 a −29,2) y ΔSPD (0,179–1,236) fueron predictoras del incremento de la FE ≥5% entre ambos estudios.
En los pacientes con miocardiopatía isquémica la práctica de un protocolo corto esfuerzo reposo puede infravalorar la FE del ventrículo izquierdo. El aturdimiento miocárdico postestrés y la posible contaminación de las imágenes de reposo con las del esfuerzo previo en el protocolo corto permitirían explicar en parte estos resultados.
The purpose of this study was to analyze left systolic ventricular function and myocardial perfusion characteristics between short one day exercise-rest and long two days gated SPECT (Single Photon Emission Computed Tomography) protocols in patients with ischemic cardiomyopathy (ICM).
A prospective study of 40 patients (59.6±8.9 years, 3 women) with IHD (left ventricular ejection fraction (EF) ≤40%) was performed with myocardial perfusion gated SPECT. From 5 to 10 days after a one-day exercise-rest study (gated SPECT-1), patients were called back for a second rest study (gated SPECT-2) in order to compare EF and differences in perfusion summed rest score (ΔSRS=SRS1–SRS2) and summed difference score (ΔSDS=SDS1–SDS2) between both protocols.
Between rest-gated SPECT-1 (short protocol) and rest-gated SPECT-2 (long protocol) EF increased (34% vs 37%, P= 0.008) in 26 patients (65%), and in 11 patients (27.5%) the increase was ≥5%. There were no significant differences in clinical and coronary angiography variables between patients with and without increase of the EF ≥5%. In the multivariate analysis, ΔSRS (95% CI: −1.1 to −29.2) and ΔSDS (0.179–1.236) were predictors for this EF increase between both studies.
Exercise-rest short protocol can underestimate EF in patients with CM. Stunning but also contamination of rest images by previous exercise images in a short protocol could explain these results.
Myocardial perfusion and function single photon emission computed tomography
2006, Journal of Nuclear Cardiology
First-pass radionuclide angiography
2006, Journal of Nuclear Cardiology
The incidence and functional consequences of RT-associated cardiac perfusion defects
2005, International Journal of Radiation Oncology Biology Physics
Purpose: Radiation therapy (RT) for left-sided breast cancer has been associated with cardiac dysfunction. We herein assess the temporal nature and volume dependence of RT-induced left ventricular perfusion defects and whether these perfusion defects are related to changes in cardiac wall motion or alterations in ejection fraction.
Methods: From 1998 to 2001, 114 patients were enrolled onto an IRB-approved prospective clinical study to assess changes in regional and global cardiac function after RT for left-sided breast cancer. Patients were imaged 30 to 60 minutes after injection of technetium 99m sestamibi or tetrofosmin. Post-RT perfusion scans were compared with the pre-RT studies to assess for RT-induced perfusion defects as well as functional changes in wall motion and ejection fraction. Two-tailed Fisher’s exact test and the Cochran-Armitage test for linear trends were used for statistical analysis.
Results: The incidence of new perfusion defects 6, 12, 18, and 24 months after RT was 27%, 29%, 38%, and 42%, respectively. New defects occurred in approximately 10% to 20% and 50% to 60% of patients with less than 5%, and greater than 5%, of their left ventricle included within the RT fields, respectively (p = 0.33 to 0.00008). The rates of wall motion abnormalities in patients with and without perfusion defects were 12% to 40% versus 0% to 9%, respectively; p values were 0.007 to 0.16, depending on the post-RT interval.
Conclusions: Radiation therapy causes volume-dependent perfusion defects in approximately 40% of patients within 2 years of RT. These perfusion defects are associated with corresponding wall-motion abnormalities. Additional study is necessary to better define the long-term functional consequences of RT-induced perfusion defects.
Clinical characteristics and referral pattern of patients with left ventricular dysfunction and significant coronary artery disease undergoing radionuclide imaging
2004, Journal of Nuclear Cardiology
Many observational studies that predict patient outcomes have examined the use of myocardial perfusion imaging results. However, a referral pattern for radionuclide testing could bias these analyses and should be determined. These patients may also differ with regard to the extent of coronary artery disease (CAD). All of these differences must be incorporated into proper outcomes examinations. We sought to identify the nuclear perfusion imaging referral pattern for patients with left ventricular (LV) dysfunction and significant CAD.
Patients with LV dysfunction and CAD (n = 2951) meeting our inclusion criteria were compared by receipt or absence of radionuclide perfusion testing within 6 months before or after angiography. Pearson χ² and Kruskal-Wallis analyses were used to examine differences in baseline characteristics and catheterization results, whereas logistic regression modeling was applied to predict nuclear imaging referral before and after catheterization. Precatheterization nuclear cohort patients were more likely to be minority patients (odds ratio [OR], 1.34; P = .0083) with previous cardiac revascularization (OR, 2.27; P = .0001), Charlson comorbidity index greater than 1 (OR, 1.146; P = .0091), and heart failure symptoms (OR, 1.62; P = .0001) than those without imaging. They were less likely to have a myocardial infarction (OR, 0.464; P = .0001). After catheterization, the nuclear patients were more likely to have had congestive heart failure (OR, 1.452; P = .0019), a myocardial infarction (OR, 1.353; P = .0371), an ejection fraction lower than 30% (OR, 1.058; P = .0002), and prior revascularization (OR, 1.880; P = .0001). In addition, they had fewer diseased vessels (OR, 0.731; P = .0001).
Bias exists in nuclear referral for patients with LV dysfunction and significant CAD and must be considered when interpreting observational studies on this topic.

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Combined exercise radionuclide angiocardiography and single photon emission computed tomography perfusion studies for assessment of coronary artery disease

Semin Nucl Med

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Sensitivity and specificity of thallium-201 perfusion scintigram under exercise in the diagnosis of coronary artery disease

J Nucl Med

Accuracy of diagnosis of coronary artery disease by radionuclide measurement of left ventricular function during rest and exercise

Circulation

Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease

Circulation

Prediction of cardiac events after uncomplicated myocardial infarction: A prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography

Circulation

Perfusion and function at rest and treadmill exercise using technetium-99m-sestamibi: Comparison of one- and two-day protocols in normal volunteers

J Nucl Med

Validation and preliminary application of simultaneous treadmill exercise ejection fraction and myocardial perfusion scintigraphy

Circulation

Myocardial perfusion and function during treadmill exercise

Circulation

Simultaneous measurement of myocardial perfusion and ventricular function during exercise from a single injection of technetium-99m sestamibi in patients with coronary artery disease

Am J Cardiol

Simultaneous assessment of regional ventricular function and perfusion utilizing iridium-191m and thallium-201 during a single exercise test

Am J Cardiac Imag