Document Detail


Technetium 99m-labeled sestamibi imaging reliably identifies retained contractile reserve in dyssynergic myocardial segments.
MedLine Citation:
PMID:  9420803     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recently there has been considerable controversy regarding the use of 99mTc-labeled sestamibi as an agent for the detection of viable myocardium. In this study we have used dobutamine-induced left ventricular wall thickening by echocardiography in regions with evidence of resting dyssynergy of the left ventricle as an indicator of retained contractile reserve and compared this with 99m Tc-labeled sestamibi uptake in the same regions. METHODS AND RESULTS: Twenty-seven patients with documented coronary artery disease and severe regional wall motion abnormalities underwent low-dose (5 to 15 micrograms/kg/min) dobutamine echocardiography and maximal (15 to 40 micrograms/kg/min) stress dobutamine 99mTc-labeled sestamibi single-photon emission computed tomographic imaging. Separate-day rest 99mTc-labeled sestamibi scanning was also performed. 99mTc-labeled sestamibi uptake was assessed semiquantitatively from grades from 1 to 4, from normal to absent perfusion. Regions with grade 3 or less uptake were considered viable by 99mTc-labeled sestamibi. Of the 34 regions with severe wall motion abnormalities by echocardiography, 32 showed improved wall thickening with low-dose dobutamine. Rest 99mTc-labeled sestamibi detected retained myocardial viability in 29 of these regions (91%) that were deemed to have contractile reserve by echocardiography (concordance: 91% [K = 0.53; p < 0.001]). Furthermore, stress-rest 99mTc-labeled sestamibi revealed completely reversible defects in five regions (16%), partially reversible defects in 24 regions (75%), and grade 4 uptake and fixed (nonviable) defects in three (9%) of these 32 regions with retained contractile reserve. CONCLUSION: Uptake of 99mTc-labeled sestamibi at rest accurately identifies regions of segmental dyssynergy in which recovery of function may be provoked by inotropic stimulation. Addition of stress dobutamine 99mTc-labeled sestamibi provides further proof of retained myocardial viability in these dysfunctional segments.
Authors:
R Senior; U Raval; A Lahiri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  2     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    1995 Jul-Aug
Date Detail:
Created Date:  1998-01-29     Completed Date:  1998-01-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  296-302     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Northwick Park Hospital, Harrow, U.K.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Dobutamine / pharmacology
Echocardiography
Female
Heart / radionuclide imaging*
Hemodynamics / drug effects
Humans
Male
Middle Aged
Myocardial Contraction*
Technetium Tc 99m Sestamibi / diagnostic use*
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
109581-73-9/Technetium Tc 99m Sestamibi; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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