Korean J Nucl Med.  2003 Oct;37(5):278-287.

Nitroglycerin-Challenged Tc-99m MIBI Quantitative Gated SPECT to Predict Functional Recovery After Coronary Artery Bypass Surgery

• Lee DS
• Kim YK
• Cheon GJ
• Paeng JC
• Lee MM
• Kim KB
• Chung JK
• Lee MC

Abstract

PURPOSE
The performance of nitroglycerin-challenged Tc-99m-MIBI quantitative gated SPECT for the detection of viable myocardium was compared with rest/ 24-hour redistribution Tl-201 SPECT. MATERIALS AND METHODS: In 22 patients with coronary artery disease, rest Tl-201/ dipyridamole stress Tc-99m-MIBI gated/ 24-hour redistribution Tl-201 SPECT were performed, and gated SPECT was repeated on-site after sublingual administration of nitroglycerin (0.6 mg). Follow-up gated SPECT was done 3 months after coronary artery bypass graft surgery. For 20 segments per patient, perfusion at rest and 24-hour redistribution, and wall motion and thickening at baseline and nitroglycerin-challenged state were quantified. Quantitative viability markers were evaluated and compared; (1) rest thallium uptake, (2) thallium uptake on 24-hour redistribution SPECT, (3) systolic wall thickening at baseline, and (4) systolic wall thickening with nitroglycerin-challenge. RESULTS: Among 100 revascularized dysfunctional segments, wall motion improved in 66 segments (66%) on follow-up gated myocardial SPECT after bypass surgery. On receiver operating characteristic (ROC) curve analysis, the sensitivity and specificity of rest and 24-hour delayed redistribution Tl-201 SPECT were 79%, 44% and 82%, 44%, respectively, at the optimal cutoff value of 50% of Tl-201 uptake. The sensitivity and specificity of systolic wall thickening at baseline and nitroglycerin-challenge were 49%, 50% and 64%, 65% at the optimal cutoff value of 15% of systolic wall thickening. Area under the ROC curve of nitroglycerin-challenged systolic wall thickening was significantly larger than that of baseline systolic wall thickening (p=0.004). CONCLUSION: Nitroglycerin-challenged quantitative gated Tc-99m-MIBI SPECT was a useful method for predicting functional recovery of dysfunctional myocardium.

Keyword

Quantitative gated myocardial SPECT; nitroglycerin; rest-redistribution Tl-201 SPECT

MeSH Terms

Administration, Sublingual
Coronary Artery Bypass*
Coronary Artery Disease
Coronary Vessels*
Dipyridamole
Follow-Up Studies
Humans
Myocardium
Nitroglycerin
Perfusion
ROC Curve
Sensitivity and Specificity
Thallium
Tomography, Emission-Computed, Single-Photon*
Transplants
Dipyridamole
Nitroglycerin
Thallium