Document Detail


Concordance between rest MIBG and exercise tetrofosmin defects: possible use of rest MIBG imaging as a marker of reversible ischaemia.
MedLine Citation:
PMID:  11383867     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Perfusion imaging combined with pharmacological stress is the study of choice in patients with ischaemic heart disease who are incapable of exercising. Some medical conditions, however, can preclude the use of pharmacological stress. In these particular situations, availability of a diagnostic test which allows for the assessment of ischaemic territory at rest would be desirable. With the purpose of providing a marker of reversible ischaemia, we evaluated myocardial iodine-123 metaiodobenzylguanidine (MIBG) uptake in regions with fixed and reversible defects defined by exercise/rest perfusion study. Fifty-four male patients with ischaemic heart disease and previous myocardial infarction were studied by means of exercise/rest tetrofosmin and MIBG single-photon emission tomography (SPET). Regional tracer uptake was quantified and expressed as a percentage of maximum peak activity. Areas with denervated but perfused myocardium and areas with ischaemic myocardium were calculated. Regions with<75% of peak activity in the exercise perfusion study were divided into two groups according to whether the increase in peak activity in the respective rest study was >10% (reversible regional defect) or <10% (fixed regional defect). These percentages were compared with the percentages of the innervation study. The area of the innervation defect was significantly larger when the perfusion defect was reversible than when it was fixed. In regions with reversible perfusion defects, the size of the area of denervated but perfused myocardium was similar to the size of the area of ischaemic myocardium. In regions with reversible defects, the percentage of myocardial MIBG uptake was not significantly different from the percentage of tetrofosmin uptake at exercise, while it was significantly lower than the percentage of tetrofosmin uptake at rest. In regions with fixed defects, the percentage of myocardial MIBG uptake was significantly lower than the percentage of tetrofosmin uptake at exercise and at rest. In patients who developed angina during exercise test, the area of denervated but perfused myocardium was significantly larger than in patients without angina (4.1+/-2.4 vs 3.4+/-2.5, P=0.02). The same trend was observed with regard to the size of the innervation defect (8.6+/-2.4 vs 5.7+/-2.2, P=0.02). It is concluded that when the use of pharmacological stress is not possible in patients incapable of exercising, rest studies with MIBG combined with rest myocardial perfusion studies may be useful as a marker of reversible ischaemia.
Authors:
M Estorch; J Narula; A Flotats; C Marí; A Tembl; J C Martín; M del Valle Camacho; A M Catafau; R Serra-Grima; I Carrió
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of nuclear medicine     Volume:  28     ISSN:  0340-6997     ISO Abbreviation:  Eur J Nucl Med     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-31     Completed Date:  2001-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7606882     Medline TA:  Eur J Nucl Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  614-9     Citation Subset:  IM    
Affiliation:
Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. mestorch@hsp.santpau.es
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MeSH Terms
Descriptor/Qualifier:
3-Iodobenzylguanidine / diagnostic use*
Adult
Aged
Coronary Circulation
Exercise Test*
Heart / innervation
Humans
Male
Middle Aged
Myocardial Ischemia / physiopathology,  radionuclide imaging*
Organophosphorus Compounds / diagnostic use*
Organotechnetium Compounds / diagnostic use*
Radiopharmaceuticals / diagnostic use*
Rest
Sympathetic Nervous System / physiopathology
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/Radiopharmaceuticals; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane; 77679-27-7/3-Iodobenzylguanidine

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