Document Detail

Nitroglycerin-augmented 201T1 reinjection enhances detection of reversible myocardial hypoperfusion. A randomized, double-blind, parallel, placebo-controlled trial.
MedLine Citation:
PMID:  9107166     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Recent observations suggest that administration of nitrates before 201Tl reinjection enhances the detection of reversible myocardial hypoperfusion. METHODS AND RESULTS: Ninety-six patients who underwent exercise-redistribution 201Tl single photon emission computed tomography (SPECT) and had persistent defects at 4-hour redistribution imaging were prospectively randomized into a double-blind protocol in which they received a reinjection of 201Tl (1.0 mCi) 5 minutes after either placebo or 0.8 mg sublingual nitroglycerin administration, followed by repeat SPECT imaging. Of the 69 patients who had coronary angiography, all except one had significant coronary stenoses. The overall extent of perfusion defect and the reversible component assessed by polar maps of the stress-redistribution images were similar in patients who received nitroglycerin or placebo. Among the 66 patients with persistent defects in the redistribution images, 58% of those receiving nitroglycerin showed improved reversibility after reinjection, compared with 33% of patients receiving placebo (P < .05). Among 68 patients with significant coronary stenoses, those who received nitroglycerin and had coronary collateral circulation were more likely to exhibit improved reversibility after reinjection than the remaining patients (50% versus 21%, P < .05). Moreover, the ratio of reversible to total defect in the vascular territories supplied by collaterals was > or = 0.50 after reinjection in 80% of patients who received nitroglycerin (n = 20) compared with 40% of the patients who received placebo (n = 15) (P < .05). CONCLUSIONS: Nitrate-augmented 201Tl reinjection significantly, albeit modestly, improves detection of defect reversibility, especially in patients with coronary collateral circulation.
Z X He; R Medrano; J T Hays; J J Mahmarian; M S Verani
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Circulation     Volume:  95     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-05-13     Completed Date:  1997-05-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1799-805     Citation Subset:  AIM; IM    
Section of Cardiology, Baylor College of Medicine, Houston, Tex 77030, USA.
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MeSH Terms
Collateral Circulation / drug effects
Coronary Angiography
Coronary Disease / radiography,  radionuclide imaging*
Coronary Vessels / drug effects,  radionuclide imaging
Double-Blind Method
Exercise Test
Heart / radionuclide imaging*
Middle Aged
Nitroglycerin / diagnostic use*,  pharmacology
Prospective Studies
Thallium Radioisotopes / diagnostic use*
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:
0/Thallium Radioisotopes; 55-63-0/Nitroglycerin

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