Baseline/postnitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction

New evidence from MRI

Assuero Giorgetti, Alessandro Pingitore, Brunella Favilli, Annette Kusch, Massimo Lombardi, Paolo Marzullo

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The aim of this study was to compare 99mTc-tetrofosm in SPECT with contrast-enhanced MRI (ceMRI), a new direct sign of myocardial fibrosis. Methods: We studied 21 patients (age, 60 ± 11 y; 19 male) with previous myocardial infarction and severe left ventricular dysfunction (ceMRI EF, 29% ± 6%). All patients underwent resting and postnitrate (intravenous isosorbide dinitrate) 99mTc-tetrofosmin gated SPECT as well as ceMRI. Scintigraphic analysis was performed using quantitative perfusion SPECT (QPS), providing the percentage radiotracer uptake and defect severity in a 20-segment model. Hyperenhancement was defined by the increase of ceMRI signal intensity 20 min after intravenous injection of gadolinium-diethylenetriaminepentaacetic acid and its regional extension as the percentage of the total segment area. Results: In ceMRI dysfunctional segments, the correlation between the extent of hyperenhancement and both 99mTc-tetrofosmin uptake and defect severity was significantly better after nitrate administration rather than at rest (P <0.0001). Using a ceMRI cutoff below 40%, 102 of 196 (52%) segments were viable, whereas 94 (48%) segments were not viable. According to receiver-operating characteristic curve analysis, diagnostic accuracies were higher for postnitrate 99mTc-tetrofosmin uptake as well as perfusion defect severity than using resting data (0.84 vs. 0.71, P <0.001; 0.89 vs. 0.76, P <0.001, respectively). Conclusion: After nitrate administration, 93mTc-tetrofosmin uptake and perfusion defect severity were closely related to ceMRI, demonstrating, in vivo, the existence of an inverse correlation between the transmural distribution of fibrosis and tracer delivery to the myocardium.

Original languageEnglish
Pages (from-to)1285-1293
Number of pages9
JournalJournal of Nuclear Medicine
Volume46
Issue number8
Publication statusPublished - 2005

Fingerprint

Left Ventricular Dysfunction
Single-Photon Emission-Computed Tomography
Perfusion
Nitrates
Fibrosis
Isosorbide Dinitrate
Gadolinium
ROC Curve
Intravenous Injections
Myocardium
Myocardial Infarction
Acids
technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane

Keywords

  • Contrast-enhanced MRI
  • Gated SPECT
  • Myocardial viability
  • Nitrates

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Baseline/postnitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction : New evidence from MRI. / Giorgetti, Assuero; Pingitore, Alessandro; Favilli, Brunella; Kusch, Annette; Lombardi, Massimo; Marzullo, Paolo.

In: Journal of Nuclear Medicine, Vol. 46, No. 8, 2005, p. 1285-1293.

Research output: Contribution to journalArticle

Giorgetti, Assuero ; Pingitore, Alessandro ; Favilli, Brunella ; Kusch, Annette ; Lombardi, Massimo ; Marzullo, Paolo. / Baseline/postnitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction : New evidence from MRI. In: Journal of Nuclear Medicine. 2005 ; Vol. 46, No. 8. pp. 1285-1293.
@article{607d056cba764f85a3d6d277a6321c48,
title = "Baseline/postnitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction: New evidence from MRI",
abstract = "The aim of this study was to compare 99mTc-tetrofosm in SPECT with contrast-enhanced MRI (ceMRI), a new direct sign of myocardial fibrosis. Methods: We studied 21 patients (age, 60 ± 11 y; 19 male) with previous myocardial infarction and severe left ventricular dysfunction (ceMRI EF, 29{\%} ± 6{\%}). All patients underwent resting and postnitrate (intravenous isosorbide dinitrate) 99mTc-tetrofosmin gated SPECT as well as ceMRI. Scintigraphic analysis was performed using quantitative perfusion SPECT (QPS), providing the percentage radiotracer uptake and defect severity in a 20-segment model. Hyperenhancement was defined by the increase of ceMRI signal intensity 20 min after intravenous injection of gadolinium-diethylenetriaminepentaacetic acid and its regional extension as the percentage of the total segment area. Results: In ceMRI dysfunctional segments, the correlation between the extent of hyperenhancement and both 99mTc-tetrofosmin uptake and defect severity was significantly better after nitrate administration rather than at rest (P <0.0001). Using a ceMRI cutoff below 40{\%}, 102 of 196 (52{\%}) segments were viable, whereas 94 (48{\%}) segments were not viable. According to receiver-operating characteristic curve analysis, diagnostic accuracies were higher for postnitrate 99mTc-tetrofosmin uptake as well as perfusion defect severity than using resting data (0.84 vs. 0.71, P <0.001; 0.89 vs. 0.76, P <0.001, respectively). Conclusion: After nitrate administration, 93mTc-tetrofosmin uptake and perfusion defect severity were closely related to ceMRI, demonstrating, in vivo, the existence of an inverse correlation between the transmural distribution of fibrosis and tracer delivery to the myocardium.",
keywords = "Contrast-enhanced MRI, Gated SPECT, Myocardial viability, Nitrates",
author = "Assuero Giorgetti and Alessandro Pingitore and Brunella Favilli and Annette Kusch and Massimo Lombardi and Paolo Marzullo",
year = "2005",
language = "English",
volume = "46",
pages = "1285--1293",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "8",

}

TY - JOUR

T1 - Baseline/postnitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction

T2 - New evidence from MRI

AU - Giorgetti, Assuero

AU - Pingitore, Alessandro

AU - Favilli, Brunella

AU - Kusch, Annette

AU - Lombardi, Massimo

AU - Marzullo, Paolo

PY - 2005

Y1 - 2005

N2 - The aim of this study was to compare 99mTc-tetrofosm in SPECT with contrast-enhanced MRI (ceMRI), a new direct sign of myocardial fibrosis. Methods: We studied 21 patients (age, 60 ± 11 y; 19 male) with previous myocardial infarction and severe left ventricular dysfunction (ceMRI EF, 29% ± 6%). All patients underwent resting and postnitrate (intravenous isosorbide dinitrate) 99mTc-tetrofosmin gated SPECT as well as ceMRI. Scintigraphic analysis was performed using quantitative perfusion SPECT (QPS), providing the percentage radiotracer uptake and defect severity in a 20-segment model. Hyperenhancement was defined by the increase of ceMRI signal intensity 20 min after intravenous injection of gadolinium-diethylenetriaminepentaacetic acid and its regional extension as the percentage of the total segment area. Results: In ceMRI dysfunctional segments, the correlation between the extent of hyperenhancement and both 99mTc-tetrofosmin uptake and defect severity was significantly better after nitrate administration rather than at rest (P <0.0001). Using a ceMRI cutoff below 40%, 102 of 196 (52%) segments were viable, whereas 94 (48%) segments were not viable. According to receiver-operating characteristic curve analysis, diagnostic accuracies were higher for postnitrate 99mTc-tetrofosmin uptake as well as perfusion defect severity than using resting data (0.84 vs. 0.71, P <0.001; 0.89 vs. 0.76, P <0.001, respectively). Conclusion: After nitrate administration, 93mTc-tetrofosmin uptake and perfusion defect severity were closely related to ceMRI, demonstrating, in vivo, the existence of an inverse correlation between the transmural distribution of fibrosis and tracer delivery to the myocardium.

AB - The aim of this study was to compare 99mTc-tetrofosm in SPECT with contrast-enhanced MRI (ceMRI), a new direct sign of myocardial fibrosis. Methods: We studied 21 patients (age, 60 ± 11 y; 19 male) with previous myocardial infarction and severe left ventricular dysfunction (ceMRI EF, 29% ± 6%). All patients underwent resting and postnitrate (intravenous isosorbide dinitrate) 99mTc-tetrofosmin gated SPECT as well as ceMRI. Scintigraphic analysis was performed using quantitative perfusion SPECT (QPS), providing the percentage radiotracer uptake and defect severity in a 20-segment model. Hyperenhancement was defined by the increase of ceMRI signal intensity 20 min after intravenous injection of gadolinium-diethylenetriaminepentaacetic acid and its regional extension as the percentage of the total segment area. Results: In ceMRI dysfunctional segments, the correlation between the extent of hyperenhancement and both 99mTc-tetrofosmin uptake and defect severity was significantly better after nitrate administration rather than at rest (P <0.0001). Using a ceMRI cutoff below 40%, 102 of 196 (52%) segments were viable, whereas 94 (48%) segments were not viable. According to receiver-operating characteristic curve analysis, diagnostic accuracies were higher for postnitrate 99mTc-tetrofosmin uptake as well as perfusion defect severity than using resting data (0.84 vs. 0.71, P <0.001; 0.89 vs. 0.76, P <0.001, respectively). Conclusion: After nitrate administration, 93mTc-tetrofosmin uptake and perfusion defect severity were closely related to ceMRI, demonstrating, in vivo, the existence of an inverse correlation between the transmural distribution of fibrosis and tracer delivery to the myocardium.

KW - Contrast-enhanced MRI

KW - Gated SPECT

KW - Myocardial viability

KW - Nitrates

UR - http://www.scopus.com/inward/record.url?scp=25444531140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25444531140&partnerID=8YFLogxK

M3 - Article

VL - 46

SP - 1285

EP - 1293

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 8

ER -