Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability

Radionuclide comparison before and after revascularization

Cesare Greco, Gaetano Tanzilli, Massimo Ciavolella, Riccardo Sinatra, Maria Banci, Orazio Schillaci, Francesco Macrina, Francesco Scopinaro, Benedetto Marino, Pietro Paolo Campa

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Nitroglycerin (NTG) is known to increase the blood supply to the myocardium, and would thus increase the delivery of a perfusional tracer such as sestamibi (MIBI) to the tissue. The latter, in turn, would take up and concentrate the tracer to a greater extent than in basal conditions only if energy-dependent mechanisms were still available - that is, only if the cells were still viable. Methods: We evaluated the changes that intravenous administration of NTG induced on the uptake of MIBI by akinetic myocardial areas, using tomographic perfusional imaging in 23 patients with previously ascertained anterior myocardial infarction who were undergoing myocardial revascularization procedures. Changes in uptake were compared with echocardiographic and perfusional changes occurring after operation. Results: The improvement of MIBI uptake after NTG correctly identified 12 of the 16 patients (75%) showing postoperative wall motion improvement; they comprised 12 of the 14 (86%) patients with NTG-induced increase in MIBI uptake who showed improved wall motion after operation. A close correlation (r = 0.88, P <0.001) was found between the increase in myocardial MIBI uptake induced by NTG infusion and that induced by revascularization. The presence of collaterals to the akinetic area was associated with a significantly (P <0.01) greater increase in MIBI uptake both during NTG infusion and after operation. Conclusions: The results of this study suggest that MIBI perfusional myocardial scintigraphy during infusion of NTG is capable of detecting viable but chronically hypoperfused myocardium, predicting postoperative wall motion and perfusional improvement, and reflecting the postoperative pattern of perfusion. The best results were achieved in patients with evidence of collateral circulation supplying the infarcted area.

Original languageEnglish
Pages (from-to)877-884
Number of pages8
JournalCoronary Artery Disease
Volume7
Issue number12
Publication statusPublished - 1996

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Tissue Survival
Nitroglycerin
Radioisotopes
Myocardium
Myocardial Revascularization
Collateral Circulation
Myocardial Perfusion Imaging
Intravenous Administration
Perfusion
Myocardial Infarction

Keywords

  • nitroglycerin
  • perfusion
  • tomography
  • viability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Greco, C., Tanzilli, G., Ciavolella, M., Sinatra, R., Banci, M., Schillaci, O., ... Campa, P. P. (1996). Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability: Radionuclide comparison before and after revascularization. Coronary Artery Disease, 7(12), 877-884.

Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability : Radionuclide comparison before and after revascularization. / Greco, Cesare; Tanzilli, Gaetano; Ciavolella, Massimo; Sinatra, Riccardo; Banci, Maria; Schillaci, Orazio; Macrina, Francesco; Scopinaro, Francesco; Marino, Benedetto; Campa, Pietro Paolo.

In: Coronary Artery Disease, Vol. 7, No. 12, 1996, p. 877-884.

Research output: Contribution to journalArticle

Greco, C, Tanzilli, G, Ciavolella, M, Sinatra, R, Banci, M, Schillaci, O, Macrina, F, Scopinaro, F, Marino, B & Campa, PP 1996, 'Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability: Radionuclide comparison before and after revascularization', Coronary Artery Disease, vol. 7, no. 12, pp. 877-884.
Greco, Cesare ; Tanzilli, Gaetano ; Ciavolella, Massimo ; Sinatra, Riccardo ; Banci, Maria ; Schillaci, Orazio ; Macrina, Francesco ; Scopinaro, Francesco ; Marino, Benedetto ; Campa, Pietro Paolo. / Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability : Radionuclide comparison before and after revascularization. In: Coronary Artery Disease. 1996 ; Vol. 7, No. 12. pp. 877-884.
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T2 - Radionuclide comparison before and after revascularization

AU - Greco, Cesare

AU - Tanzilli, Gaetano

AU - Ciavolella, Massimo

AU - Sinatra, Riccardo

AU - Banci, Maria

AU - Schillaci, Orazio

AU - Macrina, Francesco

AU - Scopinaro, Francesco

AU - Marino, Benedetto

AU - Campa, Pietro Paolo

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N2 - Background: Nitroglycerin (NTG) is known to increase the blood supply to the myocardium, and would thus increase the delivery of a perfusional tracer such as sestamibi (MIBI) to the tissue. The latter, in turn, would take up and concentrate the tracer to a greater extent than in basal conditions only if energy-dependent mechanisms were still available - that is, only if the cells were still viable. Methods: We evaluated the changes that intravenous administration of NTG induced on the uptake of MIBI by akinetic myocardial areas, using tomographic perfusional imaging in 23 patients with previously ascertained anterior myocardial infarction who were undergoing myocardial revascularization procedures. Changes in uptake were compared with echocardiographic and perfusional changes occurring after operation. Results: The improvement of MIBI uptake after NTG correctly identified 12 of the 16 patients (75%) showing postoperative wall motion improvement; they comprised 12 of the 14 (86%) patients with NTG-induced increase in MIBI uptake who showed improved wall motion after operation. A close correlation (r = 0.88, P <0.001) was found between the increase in myocardial MIBI uptake induced by NTG infusion and that induced by revascularization. The presence of collaterals to the akinetic area was associated with a significantly (P <0.01) greater increase in MIBI uptake both during NTG infusion and after operation. Conclusions: The results of this study suggest that MIBI perfusional myocardial scintigraphy during infusion of NTG is capable of detecting viable but chronically hypoperfused myocardium, predicting postoperative wall motion and perfusional improvement, and reflecting the postoperative pattern of perfusion. The best results were achieved in patients with evidence of collateral circulation supplying the infarcted area.

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