technetium-tc-99m-tetrofosmin and Angina--Unstable

Aims Although cardiac hybrid imaging, fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA), provides important complementary diagnostic information for coronary artery disease (CAD) assessment, no prognostic data exist on the predictive value of cardiac hybrid imaging. Hence, the aim of this study was to assess the prognostic value of hybrid SPECT/CCTA images. Methods and results Of 335 consecutive patients undergoing a 1-day stress/rest (99m)Tc-tetrofosmin SPECT and a CCTA, acquired on stand-alone scanners and fused to obtain cardiac hybrid images, follow-up was obtained in 324 patients (97%). Survival free of all-cause death or non-fatal myocardial infarction (MI) and free of major adverse cardiac events (MACE: death, MI, unstable angina requiring hospitalization, coronary revascularizations) was determined using the Kaplan-Meier method for the following groups: (i) stenosis by CCTA and matching reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; and (iii) normal finding by CCTA and SPECT. Cox's proportional hazard regression was used to identify independent predictors for cardiac events. At a median follow-up of 2.8 years (25th-75th percentile: 1.9-3.6), 69 MACE occurred in 47 patients, including 20 death/MI. A corresponding matched hybrid image finding was associated with a significantly higher death/MI incidence (P < 0.005) and proved to be an independent predictor for MACE. The annual death/MI rate was 6.0, 2.8, and 1.3% for patients with matched, unmatched, and normal findings. Conclusion Cardiac hybrid imaging allows risk stratification in patients with known or suspected CAD. A matched defect on hybrid image is a strong predictor of MACE.

Topics: Aged; Angina, Unstable; Cause of Death; Coronary Angiography; Coronary Artery Disease; Death, Sudden, Cardiac; Female; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiation Dosage; Radiopharmaceuticals; Risk Factors; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study is to the diagnostic accuracy and the value as prognostic predictors based on the perfusion and/or functional analysis using the QGS program on 99mTc-tetrofosmin gated SPECT (Tf-QGS-SPECT) in patients with unstable angina pectoris (UAP) who admitted to the CCU.. Fifty seven consecutive patients (37 males and 20 females, mean age: 62 +/- 7 years) with suspected UAP, who underwent Tf-QGS-SPECT and coronary angiography, were entered into this study. We compared the accuracy for diagnosing UAP in the following 3 analyses: 1. Perfusion analysis alone, 2. Functional analysis alone, 3. Perfusion analysis with functional analysis. In addition, we evaluated the prognostic values of the perfusion and/or functional analysis with Tf-QGS-SPECT.. Thirty-five of 57 patients with suspected UAP had significant coronary stenosis. The highest accuracy was obtained by adequate combination of perfusion and functional analysis (sensitivity 83%, specificity 82%, accuracy 82%). Thirteen of 29 patients with positive findings in this analysis needed emergent or urgent coronary revascularization. Five of 6 patients with false negative findings in this analysis were left circumflex artery lesions, and two of these patients needed emergent coronary revascularization.. Evaluation with perfusion and functional images using Tf-QGS-SPECT is useful to improve the accuracy of diagnosis and to predict the prognosis of patients with UAP who admitted to the CCU.

Topics: Aged; Angina, Unstable; Electrocardiography; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The determination of the myocardium at risk before intervention and the change in that region after intervention constitute a promising measurement tool for the assessment of acute therapy. A new 99mTc labeled myocardial blood flow tracer, 99mTc tetrofosmin, is expected to enable the evaluation of myocardium at risk because of the absence of redistribution. This preliminary study was performed in 9 patients with acute coronary syndrome (4 unstable angina and 5 acute myocardial infarction) to investigate whether recovery of perfusion by tetrofosmin imaging parallels mechanical improvement. Tetrofosmin imaging was performed acutely and 3-30 days later. Visual analysis of defect severity was assessed in both studies. Segments with improvement in perfusion were accompanied by significant wall motion recovery compared with normal and unimproved segments (delta WMI: normal segments 0.40 +/- 0.67, improved segments 1.79 +/- 0.68, unimproved segments -0.15 +/- 0.16, p < 0.01 for improved segments compared with other groups), suggesting the efficacy of this tracer for the assessment of the acute therapy. These data suggest that 99mTc tetrofosmin imaging is a useful method for the assessment of the myocardial area at risk and the efficacy of acute therapy in acute myocardial infarction and unstable angina.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Female; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging

The determination of the myocardium at risk before intervention and the change in that region after intervention constitute a promising measurement tool for the assessment of acute therapy. We used 99mTc PPN-1011 in 4 patients with acute myocardial ischemia (2 patients with acute myocardial infarction, 2 unstable angina) and subsequent successful reperfusion. All 4 patients had perfusion defect on the pre-reperfusion image. Perfusion abnormality on post-reperfusion image was all improved significantly compared with pre-reperfusion image, suggesting the efficacy of acute treatment in acute myocardial ischemia. We conclude that 99mTc PPN-1011 scintigraphy is useful method for the assessment of myocardial area at risk and the efficacy of PTCA/PTCR in myocardial infarction and unstable angina.

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Risk; Thrombolytic Therapy