Automated quantification of 99mTc sestamibi myocardial perfusion compared with visual analysis

Leslie, William D.; Tully, Shawn A.; Yogendran, Marina; Ward, Linda; Nour, Khaled; Metge, Colleen

doi:10.1097/01.mnm.0000133075.72292.53

Cited by 37 publications

(46 citation statements)

References 5 publications

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“…It is therefore even more intriguing that in our patient population with EF drop the event rate appears to be significantly higher than in controls, with an incidence of 5% for hard events and of 17.5% for soft events. These values appear at least comparable and possibly superior to those previously reported for patients with mild to moderate perfusion abnormalities [8,17,18].…”

Section: Comparison With Previous Studiessupporting

confidence: 87%

“…The patients were prospectively included in the follow-up registry if they showed a ≥5 EF units decrease in poststress images without stress-inducible ischaemia (as below defined) [6,8]. Because the meaning of the EF drop was still under investigation, it was our policy to avoid indicating it in the clinical report.…”

Section: Patient Populationmentioning

confidence: 99%

“…The summed difference score (SDS) represents the difference between the stress and resting scores [9]. Inducible ischaemia was classified as mild (2)(3)(4)(5), moderate (6 -7) and severe (>7) [8]. For the purpose of the study only patients with SDS=0 or =1 were selected.…”

Section: Gated Spectmentioning

confidence: 99%

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Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Dona

Massi

Settimo

et al. 2010

Eur J Nucl Med Mol Imaging

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Purpose The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. Methods We prospectively enrolled 57 consecutive patients with post-stress EF drop ≥5 EF units and summed difference score (SDS)≤1. They were followed up for more than 1 year and their outcome was compared with a group of sex-and agematched controls with the same SDS but without EF decrease. Results During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p<0.0001) between the event-free survival curves of the two groups. ConclusionThe event rate of patients with post-stress EF decrease≥5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted.

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Section: Comparison With Previous Studiessupporting

confidence: 87%

Section: Patient Populationmentioning

confidence: 99%

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Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Dona

Massi

Settimo

et al. 2010

Eur J Nucl Med Mol Imaging

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“…18 A summed difference score <2 was defined as no ischemia; 2-7 mild to moderate, and >7 as severe ischemia. 18,19 Disagreements in image interpretation were resolved by consensus.…”

Section: Visual Analysis Of Spectmentioning

confidence: 99%

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

Tanaka

Chikamori

Hida

et al. 2005

Circ J

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lthough stress-induced wall motion abnormalities usually disappear rapidly once myocardial ischemia is eliminated, there are a few cases in which wall motion abnormalities remain, even >30 min after elimination of the ischemia; myocardial stunning is the apparent mechanism in such cases. [1][2][3][4][5][6] The characteristics of technetium-99m ( 99m Tc)-sestamibi, which rarely redistributes, 7 in conjunction with electrocardiogram-gated single-photon emission computed tomography (SPECT) enables assessment of both myocardial ischemia during stress and left ventricular wall motion and function at least 30 min after the stress. 8,9 Although myocardial stunning has been mainly shown after exercise-induced ischemia, 1-6 pharmacologic vasodilation, which induces maldistribution of the blood flow in the intramyocardium, is commonly used as the method of inducing stress during myocardial perfusion imaging. Therefore, the aims of the present study were to evaluate the myocardial stunning induced by standard stress tests in clinical practice, and to compare the development of myocardial stunning with either exercise or pharmacologic stress. Methods SubjectsThe subjects were 179 consecutive patients with known or suspected coronary artery disease (CAD), who underwent exercise or adenosine triphosphate disodium (ATP) stress myocardial perfusion imaging. Patients with a history of coronary angioplasty or bypass graft surgery were considered to have known CAD, whereas those with a clinical risk profile, symptoms or electrocardiographic abnormalities were considered as having suspected CAD. Patients with a history of prior myocardial infarction were excluded. In total, there were 112 men and 67 women, with a mean age of 66±9 years, and 77 of them underwent coronary angiography because of clinical symptoms, electrocardiographic abnormalities or scintigraphic findings. Of those with known CAD, 50 patients had a history of coronary revascularization (coronary angioplasty in 39 patients, coronary artery bypass grafting in 11). Written informed consents were given by all participants. Stress 99m Tc-Sestamibi SPECTStress myocardial SPECT with 99m Tc-sestamibi was performed using a 1-day exercise -rest protocol. 10 Exercise Background Exercise gated single-photon emission computed tomography (SPECT) using technetium-99m ( 99m Tc)-sestamibi evaluates both myocardial perfusion during stress and wall motion >30 min after the stress, which has the potential to assess not only exercise-induced myocardial ischemia but also the development of myocardial stunning. Methods and ResultsTo evaluate the incidence of post-stress myocardial stunning, as well as comparing the effects of different stress methods on the development of stunning, 179 consecutive patients with known or suspected coronary artery disease (CAD) underwent 99m Tc-sestamibi SPECT with either exercise (n=135) or adenosine triphosphate disodium (ATP) (n=44). Electrocardiogram-gated SPECT images were acquired >30 min after the stress and again 4 h later, and perfusion and wall mo...

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“…19,25 Quantitation should improve risk stratification, although there are few publications to date in this regard. 26,27 Nonetheless, TPD was used to measure progression or regression of myocardial ischemia in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, 28 and is an important element of the multicenter prospective randomized ISCHEMIA study (The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) that uses a TPD ischemia score C10% as one inclusion criteria to assess invasive vs optimal medical therapy. 29 While MPI remains the most widely used cardiac radiotracer imaging modality, another important strength of nuclear cardiology is its ability to image physiologic processes other than perfusion.…”

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confidence: 99%

It’s not all in the numbers

Travin

2016

Journal of Nuclear Cardiology

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Automated quantification of 99mTc sestamibi myocardial perfusion compared with visual analysis

Abstract: Automated quantification of 99mTc sestamibi SPECT myocardial perfusion with the SSS and SDS provides objective diagnostic information and concordance when compared with conventional visual image interpretation.

Cited by 37 publications

References 5 publications

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

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