Document Detail

Low-dose dobutamine stress gated SPET for identification of viable myocardium: comparison with stress-rest perfusion SPET and PET.
MedLine Citation:
PMID:  12111128     Owner:  NLM     Status:  MEDLINE    
The detection of viable myocardium is important for the prediction of functional recovery after revascularisation. However, a fixed perfusion defect often includes viable myocardium, and perfusion imaging then underestimates myocardial viability. We previously reported that low-dose dobutamine stress gated single-photon emission tomography (SPET) provides similar findings to dobutamine stress echocardiography in the assessment of myocardial viability. The present study investigated whether low-dose dobutamine stress gated SPET is of additional value as compared with stress-rest technetium-99m tetrofosmin SPET for the detection of myocardial viability. Standard stress-rest perfusion SPET, low-dose dobutamine stress gated SPET and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) were studied in 23 patients (mean age 67+/-7.6 years) with previous myocardial infarction. Twenty-one of them were successfully studied with each technique. FDG PET viability (FDG uptake >/=50%) was employed as the gold standard. One-day stress-rest (99m)Tc-tetrofosmin myocardial SPET was performed. After the resting study, gated SPET was acquired following infusion of 7.5 microg kg(-1) min(-1) of dobutamine. Left ventricular wall motion in 16 segments was assessed by cine mode display using a four-point scale. Myocardial viability was considered present when there was improvement by one point. Of a total of 336 segments analysed, 53 had persistent defects on stress-rest perfusion SPET. FDG viability was seen in 16 of 17 dobutamine-responsive segments, but in only 11 of 36 dobutamine non-responsive segments ( P<0.01). Thus, in the segments with persistent defects, viability findings on low-dose dobutamine stress gated SPET were concordant with those on FDG PET in 77% of segments (kappa value =0.55). For the detection of FDG-viable myocardium, the combination of stress-rest perfusion SPET and low-dose dobutamine stress gated SPET achieved a better sensitivity than stress-rest perfusion SPET alone (35/46, 76% vs 19/46, 41.3%, P<0.001), with a similar specificity (25/29, 86% vs 26/29, 90%, P=NS). We conclude that in the identification of viable myocardium, low-dose dobutamine stress gated SPET may provide additional information missed on a routine stress-rest perfusion scan. Dobutamine stress gated SPET may provide new insights into myocardial viability on the basis of ischaemia and contractile reserve.
Keiichiro Yoshinaga; Chietsugu Katoh; Kazuyuki Noriyasu; Satoshi Yamada; Yoshinori Ito; Yuji Kuge; Yuko Kawai; Tetsuro Kohya; Akira Kitabatake; Nagara Tamaki
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2002-04-13
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  29     ISSN:  1619-7070     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-11     Completed Date:  2003-02-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  882-90     Citation Subset:  IM    
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-Ku, Kita 15 Nishi 7, Sapporo, 060-8638, Japan.
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MeSH Terms
Dobutamine / administration & dosage,  diagnostic use*
Exercise Test
Fluorodeoxyglucose F18 / diagnostic use*
Gated Blood-Pool Imaging / methods*
Heart / physiopathology,  radionuclide imaging
Myocardial Infarction / physiopathology*,  radionuclide imaging*,  ultrasonography
Organophosphorus Compounds / diagnostic use*
Organotechnetium Compounds / diagnostic use*
Prospective Studies
Radiopharmaceuticals / diagnostic use
Sensitivity and Specificity
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon / methods
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/Radiopharmaceuticals; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane; 34368-04-2/Dobutamine; 63503-12-8/Fluorodeoxyglucose F18

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