Characteristics of regional myocardial stunning after exercise in gated myocardial SPECT

Paul, Asit K.; Hasegawa, Shin; Yoshioka, Jun; Xiuli, Mu; Maruyama, K.; Kusuoka, Hideo; Nishimura, Tsunehiko

doi:10.1067/mnc.2002.123269

Cited by 39 publications

(17 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although visible myocardial ischemia was not observed during exercise in the regions with the 99m Tc-tetrofosmin RR phenomenon, exercise-induced myocardial ischemia cannot be ruled out as a cause of the severely deteriorated LV wall contraction, 22 because the supine ergometer exercise test may not stress the myocardium as strongly as the seated ergometer exercise test. Åstrand et al reported that maximal oxygen consumption was approximately 15% less in the supine ergometer exercise.…”

Section: Reverse Redistribution Phenomenon Of 99m Tc-tetrofosminmentioning

confidence: 93%

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

Kurokawa

Ohte

Miyabe

et al. 2003

Circ J

View full text Add to dashboard Cite

yocardial perfusion scintigraphy using as the flow tracer has been widely applied for the evaluation of myocardial ischemia and viability in patients with myocardial infarction. 1 Simultaneous evaluation of left ventricular (LV) wall motion and LV myocardial perfusion provides more information for this purpose, but as 201 Tl is not suitable as the tracer for electrocardiograph (ECG)-gated single photon emission computed tomography (SPECT), which is used for elucidating LV wall motion, echocardiography and/or left ventriculography have been the alternative techniques. 2,3 However, using a technetium (Tc)-labeled myocardial perfusion tracer, technetium-99m ( 99m Tc)-tetrofosmin, as well as 99m Tc-sestamibi allows simultaneous assessment of myocardial perfusion and LV function by ECG-gated SPECT because once these tracers are taken up by the myocardium, then the clearance is relatively slow and redistribution does not occur for several hours. [4][5][6] Several investigators have reported that in patients with acute myocardial infarction (AMI) after reperfusion therapy, myocardial imaging with 99m Tc-tetrofosmin or 99m Tcsestamibi shows a reverse redistribution (RR) phenomenon, 7-9 similar to that observed on 201 Tl scintigraphy in such patients. [10][11][12][13][14][15] The clinical significance of the RR of 201 Tl has been vigorously investigated, 10-15 compared with that on 99m Tc-tetrofosmin scintigraphy, which has not been fully elucidated. Thus, we used ECG-gated myocardial SPECT to investigate this issue in patients with AMI from the viewpoint of LV wall thickening after exercise. Methods PatientsWe studied 25 consecutive patients (17 men, 8 women, age 48-80 years) with AMI who underwent 99m Tc-tetrofosmin myocardial SPECT at rest approximately 3 weeks after the onset of infarction. Patients who had a prior myocardial infarction and/or coronary artery bypass surgery were excluded from the study. All the study patients underwent exercise stress ECG-gated SPECT with 99m Tc-tetrofosmin within 1 week of the rest study, and then selective coronary angiography was carried out. In those patients who did not Circ J 2003; 67: 830 -834 (Received February 10, 2003; revised manuscript received June 9, 2003; accepted July 9, 2003 The purpose of this study was to investigate the clinical significance of the reverse redistribution (RR) phenomenon on technetium-99m ( 99m Tc)-tetrofosmin myocardial single photon emission computed tomography (SPECT) performed at rest. Twenty-five patients underwent myocardial SPECT 3 weeks after the onset of acute myocardial infarction. Myocardial images were acquired at 40 min (early) and 4 h (delayed) after the injection of 740 MBq of 99m Tc-tetrofosmin. The regional myocardial uptake of the tracer in 26 segments of the left ventricular (LV) wall was visually scored from 0 (no activity) to 3 (normal activity), and then the RR was defined as a decrease of more than 1 point in the activity score on the delayed image compared with that on the early image. Regions with an activity score of...

show abstract

Section: Reverse Redistribution Phenomenon Of 99m Tc-tetrofosminmentioning

confidence: 93%

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

Kurokawa

Ohte

Miyabe

et al. 2003

Circ J

View full text Add to dashboard Cite

show abstract

“…It is therefore apparent that post-stress myocardial stunning can be used as a highly specific marker of extensive or severe CAD. 9,25 Transient ischemic dilatation of the left ventricle and increased thallium uptake by the lungs are both well-known indexes for severe CAD, [26][27][28] but are usually seen in patients with multivessel CAD. From our results, it is noteworthy that post-stress myocardial stunning appears even in patients with 1-vessel CAD, if there is high-grade coronary narrowing.…”

Section: Discussionmentioning

confidence: 99%

“…[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][2][3][4][5][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.…”

mentioning

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

View full text Add to dashboard Cite

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...

show abstract

“…Transient ischemia can produce perfusion defects associated with left ventricular contractile dysfunction, and one third of patients show persistent dysfunction (17,18). The association between perfusion defects and wall motion abnormalities could have important pathophysiologic and clinical implications.…”

Section: Comparison Of Left Ventricular Function On Early and Delayedmentioning

confidence: 99%

Feasibility and Diagnostic Accuracy of a Gated SPECT Early-Imaging Protocol: A Multicenter Study of the Myoview Imaging Optimization Group

Giorgetti¹,

Rossi²,

Stanislao³

et al. 2007

Journal of Nuclear Medicine

View full text Add to dashboard Cite

The aim of this study was to investigate whether early (time 1, or T1) myocardial tetrofosmin imaging is feasible and as accurate in detecting coronary artery disease as is standard delayed (time 2, or T2) imaging. Methods: One hundred twenty patients (100 men and 20 women; mean age 6 SD, 61 6 10 y) with anginal symptoms underwent tetrofosmin gated SPECT. Stress/rest T1 imaging was performed at 15 min and T2 at 45 min after injection. Image quality was visually evaluated using a 4-point scale (from 0 5 poor to 3 5 optimal). Myocardial perfusion analysis was performed on a 20-segment model using quantitative perfusion SPECT software, and reversible ischemia was scored as a summed difference score (SDS). Coronary angiography was performed within 1 mo on all patients, and stenosis of more than 50% of the diameter was considered significant. Results: Overall, quality was scored as optimal or good for 94% of T1 images and 95% of T2 images (P 5 not statistically significant). Heart, lung, liver, and subdiaphragmatic counts did not differ for stress and rest T1 and T2 imaging. A good linear relationship was seen between T1 and T2 SDS (r 5 0.69; P , 0.0001), and Bland-Altman analysis showed good agreement between the 2 conditions. In terms of global diagnostic accuracy, areas under the receiver-operating-characteristic curve were comparable between T1 and T2 (0.80 vs. 0.81, P 5 not statistically significant). Discrepancies between T1 and T2 SDS were observed in 44% of patients (T1 2 T2 SDS . 2). Linear regression analysis showed a good correlation between T1 and T2 SDS (r 5 0.67; P , 0.0001), whereas the Bland-Altman method showed a shift in the mean value of the difference of 12.67 6 2.73. In patients with a T1 2 T2 SDS of more than 2, areas under the receiveroperating-characteristic curves were significantly higher for T1 than for T2 images (0.79 vs. 0.70, P , 0.001). Conclusion: T1 imaging is feasible and as accurate as T2 imaging in identifying coronary artery disease. However, in a discrete subset of patients, early acquisition strengthens the clinical message of defect reversibility by permitting earlier, more accurate identification of more severe myocardial ischemia.

show abstract

Characteristics of regional myocardial stunning after exercise in gated myocardial SPECT

Cited by 39 publications

References 0 publications

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

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

Feasibility and Diagnostic Accuracy of a Gated SPECT Early-Imaging Protocol: A Multicenter Study of the Myoview Imaging Optimization Group

Contact Info

Product

Resources

About