Dobutamine 99Tcm-MIBI SPET myocardial perfusion scintigraphy in the prediction of restenosis after percutaneous transluminal coronary angioplasty in patients unable to perform an exercise stress test

Elhendy, Abdou; Geleijnse, Marcel L.; Roelandt, J. R. T. C.; Domburg, Ron T. van; Nierop, Peter R; Bax, Jeroen J.; Kasprzak, J. D.; El-Said, Galal M.; Ibrahim, M. Mohsen; Fioretti, P.

doi:10.1097/00006231-199702000-00006

Cited by 11 publications

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“…Stress images were acquired one hour after termination of the test. For resting studies 370 MBq of sestamibi were injected at least 24 hours after the stress study 9. For each study we defined six oblique (short axis) slices from the apex to the base and three sagittal (vertical long axis) slices from the septum to the lateral wall.…”

Section: Methodsmentioning

confidence: 99%

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities

Elhendy

Domburg

Bax

et al. 2000

Heart

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Aim-To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia. Methods-147 patients with significant coronary artery disease and new or worsening wall motion abnormalities during DSE were enrolled. Left ventricular function was evaluated using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesis. Simultaneous sestamibi SPECT myocardial perfusion imaging was performed in all patients. Results-Severe worsening of regional function (an increase in wall motion score of two grades or more in > 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in > 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v 1.97 (0.8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95% v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0.01), and more stress perfusion defects (3.8 (1.5) v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0.005, 2 = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, 2 = 4.3) as independent variables associated with severe worsening of regional function. Conclusions-The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease. (Heart 2000;83:35-39)

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Section: Methodsmentioning

confidence: 99%

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities

Elhendy

Domburg

Bax

et al. 2000

Heart

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“…Examining these issues in detail is beyond the scope of this review; however, some of them are inescapable, as they are directly related to the process of diagnosing R. For instance, more than a dozen different definitions for AngR exist [2,17]. In the literature reviewed by us, AngR was determined as a ‡50% diameter stenosis in 12 studies [7,8,28,31,34,35,41,50,51,53,54,57], ‡70% diameter stenosis in four studies [42,44,52,58] and by other criteria (loss of gain) in four studies [16,45,55,56]. This topic is not the only one with such a high variability.…”

Section: Complexity Of Defining Restenosismentioning

confidence: 99%

Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performance

Dori

Denekamp

Fishman

et al. 2003

Journal of Internal Medicine

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When chest symptoms recur in a patient who underwent percutaneous transluminal coronary angioplasty (PTCA), it is necessary to rule out restenosis (R). Three main noninvasive tests suggest the presence of R: exercise stress test (XT), myocardial perfusion imaging (MPI) and stress echocardiography (s-echo). The objectives of this review were: (1) to estimate the pretest probability of R as a function of time after PTCA in symptomatic patients and (2) to obtain an approximation of the diagnostic parameters of the XT, MPI and s-echo for detecting R. A MEDLINE search (English-language, years: 1980-2001) was conducted to identify studies examining post-PTCA functional testing for diagnosing R. Data from the studies were pooled. Comparing studies was often difficult due to varying methodology in the studies. Pretest probability of R in symptomatic patients increases in a nonlinear fashion from 20% or less at 1 month, to nearly 90% at 1-year postangioplasty. The approximated accuracy of the XT, MPI, and s-echo for detecting R was 62, 82 and 84%, respectively. During the first month after PTCA, none of the noninvasive modalities is able to accurately detect R. Late (7-9 months) after PTCA, the pretest probability of R is high and therefore the noninvasive measure may be spared. Our analysis suggests that MPI and s-echo should be preferred over the XT for diagnosing R.

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“…Stress radionuclide imaging can detect compromised myocardial perfusion after PCI with a reportedly fair to good accuracy. [6][7][8][9][10][11][12][13][14][15] In this study we showed that dobutamine stress MCPI was a useful method for detection of compromised perfusion due to restenosis and CAD involving arteries without previous interventions in 56 patients who were evaluated at a mean of 1.9 years after PCI. The test was tolerated without serious complications.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Studies of myocardial perfusion after percutaneous coronary intervention (PCI) have used radionuclide imaging to detect restenosis. [6][7][8][9][10][11][12][13][14][15] There are no data on the utility of myocardial contrast perfusion imaging (MCPI) in the evaluation of patients with previous PCI. The objective of this study was to assess the accuracy of dobutamine stress real-time MCPI for the diagnosis of restenosis and evaluation of extent of CAD in patients with previous PCI.…”

mentioning

confidence: 99%

Evaluation of restenosis and extent of coronary artery disease in patients with previous percutaneous coronary interventions by dobutamine stress real-time myocardial contrast perfusion imaging

Elhendy

Tsutsui

O’Leary

et al. 2006

Heart

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OBJECTIVE-The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined. RESEARCH DESIGN AND METHODS-Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as 50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability. RESULTS-CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83-95), specificity 52% (33-71), and accuracy 81% (75-88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65-85) for left anterior descending CAD, 71% (60-83) for left circumflex, and 67% (55-78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%). CONCLUSIONS-MCPI is a useful noninvasive technique for the diagnosis and localiza-tion of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity.

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Dobutamine 99Tcm-MIBI SPET myocardial perfusion scintigraphy in the prediction of restenosis after percutaneous transluminal coronary angioplasty in patients unable to perform an exercise stress test

Cited by 11 publications

References 0 publications

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities

Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performance

Evaluation of restenosis and extent of coronary artery disease in patients with previous percutaneous coronary interventions by dobutamine stress real-time myocardial contrast perfusion imaging

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