Use of exercise technetiumtium-99m sestamibi SPECT imagina to detect residual ischemia and for risk stratification after acute myocardial infarction

Travin, Mark I.; Dessouki, Amr; Cameron, Tina; Helle, Gary V.

doi:10.1016/s0002-9149(99)80650-x

Cited by 72 publications

(18 citation statements)

References 23 publications

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“…Travin et al 47 reported that the presence of either ischemia seen on SPECT 99m Tc-labeled sestamibi imaging or defects detected in multiple vascular regions identified 92% of patients who subsequently experienced an event after hospital discharge. By Cox regression analysis of clinical, ECG stress test, and image variables, the number of ischemic defects on SPECT 99m Tcsestamibi imaging was the only significant correlate of future events in patients with Ͼ3 reversible 99m Tc-sestamibi defects having an event rate of 38%.…”

Section: Risk Stratification After Acute Myocardial Infarctionmentioning

confidence: 99%

Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease

2000

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In the past decade, significant advances have been made in the ability to image the heart with radionuclide tracers under stress and resting conditions in patients with suspected or known coronary artery disease (CAD) for the detection of ischemia, determination of prognosis, assessment of myocardial viability, preoperative risk assessment for patients undergoing noncardiac surgery, and evaluation of the efficacy of revascularization in patients undergoing coronary artery bypass surgery or an interventional procedure. 1 For many years, planar imaging and SPECT with 201 Tl constituted the only scintigraphic techniques available for detecting CAD and assessing prognosis in patients undergoing stress perfusion imaging. The major limitation of 201 Tl scintigraphy is the high false-positive rate observed in many laboratories, which is attributed predominantly to image attenuation artifacts and variants of normal that are interpreted as defects consequent to a significant coronary artery stenosis. Although quantification of 201 Tl images improves specificity, the false-positive rate remains problematic, particularly in women and in obese patients. Breast attenuation artifacts in women are sometimes difficult to distinguish from perfusion abnormalities secondary to inducible ischemia or myocardial scar.In recent years, new 99m Tc-labeled perfusion agents have been introduced into clinical practice to enhance the specificity of SPECT and to provide additional information regarding regional and global left ventricular systolic function via ECG gating of images. It was immediately apparent that the quality of images obtained with these new 99m Tc-labeled radionuclides was superior to that of images obtained with 201 Diagnosis of CAD Exercise Perfusion ImagingPerhaps 1 of the most significant advances in myocardial perfusion imaging in the past decade is the development of quantitative SPECT perfusion imaging. With planar imaging incorporating visual assessment of myocardial scintigrams, sensitivity and specificity for detection of CAD averaged 82% and 88%, respectively, in Ϸ4000 patients combined from multiple published series. 4 The sensitivity and specificity of quantitative planar 201 Tl scintigraphy were significantly higher at 91% and 89%, respectively, in 682 patients from studies published in the literature. 5 With tomographic SPECT technology, sensitivity averaged 92% (range, 82% to 98%) with a specificity of 68% in 1447 patients combined from 6 studies in the literature. The specificity for CAD detection was only 68% (range, 44% to 91%), which is most likely attributed to a referral bias in which patients with abnormal scans are more likely to be referred for coronary angiography than patients with normal scans. The normalcy rate was 84%. The normalcy rate, used as a surrogate for specificity, is defined as the rate of normal perfusion scans in patients with Ͻ5% likelihood of CAD on the basis of clinical and ECG stress test data. It is of interest that the sensitivity of SPECT remains high (85%) for CAD detec...

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Section: Risk Stratification After Acute Myocardial Infarctionmentioning

confidence: 99%

Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease

2000

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“…However, given that MPI is an imaging technique measuring flow enhancement in diverse myocardial beds based on changes in relative radiotracer uptake [26], there arise distinct limitations in its use in the evaluation of patients with multivessel disease (MVD) [7,10]. In particular, the allocation of perfusion defects to their determining coronary arteries or specific coronary lesions-a precondition for performing appropriate percutaneous coronary intervention (PCI) [15,16,36]-is frequently hampered when morphological correlation is not available [7,10,35,41,23,40]. Additionally, the detection of ischemic myocardial regions might be compromised in patients with fixed perfusion defects due to the presence of myocardial scaring or chronic hypo perfusion, as has been shown in a recent study [32].…”

Section: Introductionmentioning

confidence: 99%

Tc-99m sestamibi single photon emission computed tomography for guiding percutaneous coronary intervention in patients with multivessel disease: a comparison with quantitative coronary angiography and fractional flow reserve

Förster¹,

Rieber²,

Übleis³

et al. 2009

Int J Cardiovasc Imaging

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To evaluate the accuracy of myocardial perfusion SPECT (MPI) in the detection and allocation of vessel specific perfusion defects (PD) using standard distribution territories in a routine clinical procedure of patients with multivessel disease (MVD). Combined quantitative coronary angiography and fractional flow reserve (QCA/FFR) measurements were used as invasive reference standard. 216 vessels in 72 MVD patients (67 +/- 10 years, 28 female) were investigated using MPI and QCA. FFR of 93 vessels with intermediate stenoses was determined. MPI detected significant stenoses according to QCA/FFR findings with a sensitivity of 85%. However, vessel-based evaluation using standard myocardial distribution territories delivered a sensitivity of only 62% (28 MPI+ out of 45 (QCA/FFR)+ findings), with specificity, PPV and NPV of 90, 62 and 90%. 7/17 false positive and 7/17 false negative findings (41%) could be attributed to incorrect allocation of reversible PD to their respective coronary arteries. 6/17 (35%) perfusion territories were classified as false negative when additional fixed PD were present. MPI had reasonable sensitivity for the detection of significant coronary artery disease in patients with multivessel disease. However, sensitivity decreased markedly, when the significance of each individual stenosis was evaluated using standard myocardial supplying territories. In this setting, 41% of false negative and false positive MPI findings resulted from incorrect allocation of reversible perfusion defects to their determining supplying vessel.

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“…Both are particularly germane to the INSPIRE trial in that they have strongly influenced current practice guidelines; and, within the cardiology community, have expanded the existing widespread use of an invasive approach to now include patients with AMI. These trials chose ETT as the noninvasive testing standard-a suboptimal technique for detecting ischemia (20,21) or predicting risk compared with perfusion imaging (3,20). Furthermore, in the TACTICS study ϳ40% of all cardiac events occurred in the conservative strategy before the index stress test.…”

Section: Discussionmentioning

confidence: 99%

A Multinational Study to Establish the Value of Early Adenosine Technetium-99m Sestamibi Myocardial Perfusion Imaging in Identifying a Low-Risk Group for Early Hospital Discharge After Acute Myocardial Infarction

Mahmarian

Shaw

Filipchuk

et al. 2006

Journal of the American College of Cardiology

122

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Use of exercise technetiumtium-99m sestamibi SPECT imagina to detect residual ischemia and for risk stratification after acute myocardial infarction

Cited by 72 publications

References 23 publications

Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease

Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease

Tc-99m sestamibi single photon emission computed tomography for guiding percutaneous coronary intervention in patients with multivessel disease: a comparison with quantitative coronary angiography and fractional flow reserve

A Multinational Study to Establish the Value of Early Adenosine Technetium-99m Sestamibi Myocardial Perfusion Imaging in Identifying a Low-Risk Group for Early Hospital Discharge After Acute Myocardial Infarction

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