Acampa Wanda, Cuocolo Alberto, Petretta Mario, Bruno Andrea, Castellani Massimo, Finzi Andrea, Gerundini Paolo
Nuclear Medicine Center of the National Council of Research (CNR), Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy.
J Nucl Cardiol. 2002 Jan-Feb;9(1):33-40. doi: 10.1067/mnc.2002.118122.
Technetium 99m tetrofosmin has been introduced as a myocardial perfusion agent, providing similar results to those of thallium 201 and sestamibi in the identification of patients with coronary artery disease. No data are available comparing tetrofosmin and sestamibi imaging in the identification of reversible left ventricular (LV) dysfunction in the same patients. This study compared the results of tetrofosmin, thallium, and sestamibi single photon emission computed tomography at rest in detection of myocardial viability in patients with previous myocardial infarction.
Seventeen patients with previous myocardial infarction who were undergoing coronary revascularization were studied. Echocardiography was performed at baseline and 3 months after revascularization to evaluate recovery of LV function. The optimal threshold cutoffs to separate reversible from irreversible dysfunction, as determined by receiver operating characteristic analysis, were 55% of peak activity for both tetrofosmin and sestamibi and 60% for thallium. In all asynergic segments (n = 77) analyzed, tetrofosmin uptake correlated with both sestamibi (r = 0.90, P <.0001) and thallium (r = 0.85, P <.0001) activity. The sensitivity and specificity for reversible dysfunction were, respectively, 70% and 70% for tetrofosmin, 70% and 66% for sestamibi, and 60% and 68% for thallium imaging (all P = not significant). The areas under the receiver operating characteristic curves constructed for tetrofosmin, thallium, and sestamibi activity were 0.74 +/- 0.06 (mean +/- SD), 0.75 +/- 0.06, and 0.74 +/- 0.06, respectively (all P = not significant). Concordance for detecting myocardial viability between tetrofosmin and thallium imaging was found in 67 regions (87%) (kappa = 0.74), and concordance between tetrofosmin and sestamibi imaging was found in 69 regions (90%) (kappa = 0.79).
The diagnostic performance of quantitative rest tetrofosmin single photon emission computed tomography in predicting functional recovery after revascularization is comparable to that of both thallium and sestamibi scintigraphy in patients with myocardial infarction and chronic LV dysfunction.
锝99m替曲膦已作为一种心肌灌注剂被引入，在识别冠心病患者方面提供了与铊201和 sestamibi相似的结果。在同一患者中，尚无比较替曲膦和 sestamibi成像在识别可逆性左心室（LV）功能障碍方面的数据。本研究比较了替曲膦、铊和 sestamibi静息单光子发射计算机断层扫描在检测既往心肌梗死患者心肌存活情况的结果。
对17例正在接受冠状动脉血运重建的既往心肌梗死患者进行了研究。在基线和血运重建后3个月进行超声心动图检查以评估左心室功能的恢复情况。通过受试者操作特征分析确定的区分可逆性功能障碍和不可逆性功能障碍的最佳阈值截断值，替曲膦和 sestamibi均为峰值活性的55%，铊为60%。在所有分析的无运动节段（n = 77）中，替曲膦摄取与 sestamibi（r = 0.90，P <.0001）和铊（r = 0.85，P <.0001）活性均相关。替曲膦对可逆性功能障碍的敏感性和特异性分别为70%和70%，sestamibi为70%和66%，铊成像为60%和68%（所有P值均无统计学意义）。为替曲膦、铊和 sestamibi活性构建的受试者操作特征曲线下面积分别为0.74±0.06（均值±标准差）、0.75±0.06和0.74±0.06（所有P值均无统计学意义）。在67个区域（87%）发现替曲膦和铊成像在检测心肌存活方面具有一致性（kappa = 0.74），在69个区域（90%）发现替曲膦和 sestamibi成像具有一致性（kappa = 0.79）。
定量静息替曲膦单光子发射计算机断层扫描在预测心肌梗死和慢性左心室功能障碍患者血运重建后功能恢复方面的诊断性能与铊和 sestamibi闪烁扫描相当。
