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

Bone marrow-derived stem cells (BMSC) may represent a viable option for patients with myocardial ischemia refractory to conventional treatments.. In 5 patients (4 males and 1 female, mean age 64 +/- 8 years) with untreatable angina pectoris (Canadian Cardiovascular Society Class III/IV), myocardial segments with stress-induced ischemia as assessed by gated single-photon emission computed tomography were injected with 4 to 12 million CD133+ BMSC. Cells were injected into the myocardium (2 anterior, 2 lateral, 1 inferior wall) through minimally invasive approaches (left minithoracotomy [n = 4] and subdiaphragmatic approach [n = 1]). At baseline, at 6 months and at 1 year of follow-up, an exercise test, gated single-photon emission computed tomography (SPECT), 2-D echocardiography and coronary angiography were performed to assess exercise capacity, myocardial perfusion, LV function and coronary anatomy.. Intramyocardial injection of autologous CD133+ BMSC cells was safe. No early or long-term complications were observed. After an average of 3.8 weeks from cell inoculation, all patients experienced a significant improvement of CCS class (from 3.8 to 1.8 at 6 months) and serial SPECT documented improvements of rest and stress perfusion in the injected territories at 6 months from operation. In 3 cases, coronary angiography showed an increase in the collateral score of the target areas. Clinical improvements still persist unchanged in 4 out of 5 cases at a mean of 36.5 months postoperatively.. After stand-alone BMSC transplantation for refractory myocardial ischemia, we observed long-term clinical and perfusion improvements in the absence of adverse events.

Topics: AC133 Antigen; Aged; Angina Pectoris; Antigens, CD; Female; Glycoproteins; Hematopoietic Stem Cell Mobilization; Humans; Injections; Male; Mesenchymal Stem Cell Transplantation; Middle Aged; Myocardial Ischemia; Neovascularization, Physiologic; Organophosphorus Compounds; Organotechnetium Compounds; Peptides; Pilot Projects; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous

Cell therapy has recently been introduced to treat patients with refractory angina. Because most studies have only included short-term follow-up, the effects of cell therapy over a longer period are unknown.. In 25 patients (mean age 64 +/- 10 years, 21 men) with refractory angina, a total of 84 +/- 29 x 10(6) bone marrow-derived mononuclear cells was injected intramyocardially in regions with ischemia on technetium-99m tetrofosmin single-photon emission computed tomography. Anginal symptoms and quality of life were evaluated at baseline and at 3, 6, and 12 months. Gated single-photon emission computed tomography was performed at baseline and at 3 and 12 months to assess myocardial perfusion and left ventricular function.. Bone marrow cell injection was performed without any complication. At 7 months, one patient died of intracranial hemorrhage. Canadian Cardiovascular Society class improved from 3.4 +/- 0.5 to 2.3 +/- 0.6 at 3 months, 2.4 +/- 0.6 at 6 months, and 2.7 +/- 0.8 at 12 months (P < .01). Quality of life improved from 53% +/- 10% to 71% +/- 11% at 3 months, 72% +/- 14% at 6 months, and 68% +/- 14% at 12 months (P < .01). The number of segments with ischemia per patient decreased from 4.7 +/- 3.3 to 2.1 +/- 2.6 at 3 months and 1.6 +/- 2.5 at 12 months (P < .01). Left ventricular ejection fraction increased from 47% +/- 13% to 53% +/- 17% at 3 months and 51% +/- 17% at 12 months (P < .01). Regional wall motion improved from 5.9 +/- 1.7 to 6.6 +/- 2.2 mm at 3 months and 6.4 +/- 2.0 mm at 12 months (P = .01).. Autologous bone marrow cell injection in patients with ischemia is safe and results in a sustained beneficial effect on anginal symptoms, myocardial perfusion, and left ventricular function.

Topics: Aged; Angina Pectoris; Bone Marrow Transplantation; Chronic Disease; Coronary Circulation; Female; Follow-Up Studies; Heart; Humans; Injections; Male; Middle Aged; Monocytes; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Treatment Outcome; Ventricular Function, Left

There is no obvious explanation, except placebo, to the symptomatic effect of transmyocardial laser revascularization (TMR) in patients with refractory angina. Whether TMR improves myocardial perfusion or relieves symptoms without altering cardiac function is not clarified.. One hundred patients with refractory angina were randomized 1:1 to TMR (CO2 laser) and medical treatment, or medical treatment alone. Technetium 99m (99mTc)-tetrofosmin myocardial perfusion tomography (SPECT), quantitative myocardial perfusion gated SPECT (QGSPECT), technetium 99m (99mTc) multiple gated acquisition radionuclide ventriculografi (MUGA) and cine-magnetic resonance imaging (cine-MRI) were performed at baseline and after 3 and 12 months.. Following TMR, a slight reduction in left ventricular ejection fraction (LVEF) (p < 0.05) was observed (MUGA and QGSPECT) compared to baseline. Inclusion of incomplete studies (QGSPECT) revealed a significant reduction in LVEF and increase in left ventricular end-diastolic volume (LVEDV) (p < 0.05) compared to a control group. Otherwise, no between-group comparisons showed statistically significant differences.. TMR did not improve myocardial perfusion, but led to a reduction in LVEF and increase in LVEDV, however not significantly different from the control group.

Topics: Aged; Angina Pectoris; Cardiac Volume; Coronary Circulation; Female; Gated Blood-Pool Imaging; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Systole; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

A one-hour protocol for stress myocardial scintigraphy using technetium-99m-tetrofosmin (Tc-tetrofosmin) was compared with coronary arteriography for the detection of coronary artery stenosis in 90 consecutive patients without prior myocardial infarction, revascularization procedure or vasospastic angina. Tc-tetrofosmin stress myocardial scintigraphy acquired a rest image 20 min after intravenous administration of Tc-tetrofosmin (185 MBq, 1/5 vial) using a three-head gamma camera collecting 20-sec views over 360 degrees. The stress test using bicycle ergometer was performed and administration of Tc-tetrofosmin (740 MBq, 4/5 vial) was repeated at the peak stress point. The stress image was acquired 15 min after the second injection with 5-sec views over 360 degrees. Coronary arteriography revealed the presence of significant coronary artery stenosis (> 75%) in 56 vessels of 45 patients, including 35 patients with single-vessel disease, 5 with two-vessel disease, 2 with three-vessel disease, and 3 with left main trunk disease. The overall sensitivity and specificity for the detection of coronary artery disease by visual analysis were 91.1% and 77.8%, respectively, and by quantitative analyses (using bull's-eye method) were 95.6% and 91.1%, respectively. The individual stenotic vessel sensitivities in the right coronary artery, left anterior descending artery, and left circumflex artery were 84.6%, 90.9%, and 78.6%, respectively. The specificities were 97.3%, 95.9%, and 100.0%, respectively. These results suggest that stress myocardial scintigraphy using the present new protocol is a promising approach for the detection of coronary artery stenosis.

Topics: Angina Pectoris; Coronary Angiography; Coronary Disease; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity

Recent trials with selected patients have indicated that 99Tcm-tetrofosmin is a suitable agent for myocardial perfusion imaging. We performed 99Tcm-tetrofosmin perfusion imaging in an unselected group of 297 patients routinely referred to our department. Single photon emission tomographic (SPET) imaging was performed 45-60 min post-injection using a 2-day stress and rest protocol. Altogether, 192 patients were stressed on a treadmill and 105 using intravenous dobutamine. Comparison with angiography was possible in 86 patients, 65 of whom had atheromatous coronary artery disease and 21 of whom had normal coronary arteries (6 of whom fulfilled the criteria for syndrome X). The sensitivity for the detection of coronary artery disease was 94% (93% for exercise stress and 95% for dobutamine). The overall specificity was 85% (87% for exercise stress and 80% for dobutamine in the 15 normal patients and the segments supplied by disease-free coronary vessels in patients with disease elsewhere). We conclude that 99Tcm-tetrofosmin is a highly sensitive and specific agent for the detection of coronary artery disease, using both exercise and dobutamine stress, with few limitations.

Topics: Adult; Aged; Angina Pectoris; Chest Pain; Coronary Angiography; Coronary Disease; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Rest; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The clinical usefulness of a new myocardial perfusion imaging agent, 99mTc-1,2-bis[bis(2-ethoxyethyl)phosphino]ethane (99mTc-Tetrofosmin, (PPN1011) was evaluated in 355 patients with various heart diseases. Both 1 and 2 day protocols resulted in images that were significantly clearer than those of 201Tl. The absence of significant drug related adverse reaction supported the safety of the agent for clinical use. Regional abnormalities detected by CAG agreed with 99mTc-Tetrofosmin SPECT findings in 74% and with 201Tl SPECT in 78% of this study. Eighty-four percent of an abnormalities were detected with 99mTc-Tetrofosmin SPECT, as compared with those detected with 201Tl SPECT (88.4%). The complete concordance ratio between 99mTc-Tetrofosmin and 201Tl images in segmental analysis was 87-89% at rest and stress. Since 99mTc-Tetrofosmin SPECT was judged clinically useful in 93.2% (331/355) of the patients studied, it is concluded that 99mTc-Tetrofosmin is a promising agent for myocardial perfusion imaging. The simple labeling procedure without heating and cooling is suitable for emergency administration. Reconditioning of myocardial perfusion could be evaluated with 99mTc-Tetrofosmin injection before and after interventional therapy. These are additional features of the agent for clinical use.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiomyopathies; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with cardiac CT was practised in order to define the anatomy.

Topics: Adult; Angina Pectoris; Cardiac Surgical Procedures; Coronary Angiography; Coronary Vessels; Humans; Male; Myocardial Bridging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome

This prospective study evaluated the relationship between preinfarction angina (2 months before a 1st acute myocardial infarction) and the extent of postinfarction myocardial injury, myocardial perfusion, contractile function, and late recovery of global left ventricular contractile function. We enrolled 46 patients who had been admitted for a 1st, single-vessel-disease, acute myocardial infarction. Low-dose dobutamine echocardiography and technetium-99m-tetrofosmin scintigraphy were performed on all patients 7 to 10 days after acute myocardial infarction; and resting echocardiography was performed 7 to 12 months later. Twenty-seven of 46 (58.7%) patients had experienced angina before acute myocardial infarction, and 19 of 46 (41.3%) had not. There was no difference between the 2 groups in acute basal left ventricular ejection fraction (P=0.17) or in basal wall motion score index (P=0.521). The maximal creatine kinase-MB level was lower in the preinfarction-angina group (P=0.039). Patients with preinfarction angina had significantly more myocardial segments with preserved regional contractile function (P <0.0001) and significantly fewer segments with less than 50% perfusion (P=0.008). Stepwise regression analysis identified preinfarction angina (r2=0.317, P=0.032) as a significant predictor of the percentage of left ventricular ejection fraction recovery after the follow-up period. In our study, preinfarction angina was associated with decreased infarct size and with better protection of global and regional left ventricular contractility and improved preservation of the microvasculature. A history of preinfarction angina should be of value in predicting the late clinical outcomes of patients after a 1st acute myocardial infarction.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiotonic Agents; Collateral Circulation; Dobutamine; Female; Humans; Ischemic Preconditioning, Myocardial; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Stroke Volume; Time Factors; Treatment Outcome; Ultrasonography

The cardiovascular disease is the main cause of death among diabetic patients, which makes it crucial to identify the individuals at higher risk of cardiovascular events.. To evaluate the prognostic value of scintigraphy with gated single photon emission computed tomography (SPECT) in patients with diabetes mellitus (DM) and suspected coronary artery disease.. Retrospective study with 232 diabetic patients submitted to scintigraphy with gated SPECT. Perfusion Gated SPECT (scores and number of altered segments) as well as ventricular function parameters (ejection fraction, left ventricle (LV) volume and contractility) were evaluated. Cardiac death, acute ischemic coronary syndrome, revascularization procedures or encephalic vascular accident were considered future cardiovascular events. The uni- and multivariate analyses were carried out by the multiple logistic regression model (p< 0.05).. At the univariate analysis, age (p=0.02), chest angina (p=0.01), insulin therapy (p=0.02), myocardial perfusion abnormalities (p<0.0001), the number of segments involved (p=0.0001), the perfusion scores (p=0.0001), the ejection fraction (p=0.004), the final systolic volume (p=0.03) and the finding of segmental alteration at the left ventricle contractility (p<0.0001) were associated with future events at the univariate analysis. At the multivariate analysis, the male sex (p=0.007), age (p=0.03), angina (p=0.001), insulin therapy (p=0.007) and the SDS > 3 (p=0.0001) and the number of altered segments > 3 (p=0.0001) were predictors of cardiovascular events.. The myocardial scintigraphy with gated SPECT adds independent information to the stratification of the risk of future cardiovascular events in patients with DM and suspected coronary artery disease.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Angina Pectoris; Diabetes Mellitus; Epidemiologic Methods; Female; Humans; Insulin; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Sex Factors; Tomography, Emission-Computed, Single-Photon; Ventricular Function

Bone marrow cell injection has been introduced to treat patients with ischemic heart disease. However, focal application of bone marrow cells may generate an arrhythmogenic substrate.. To assess the electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic myocardial ischemia.. Bone marrow was aspirated in 20 patients (65+/-11 years, 19 male) with drug-refractory angina and myocardial ischemia. Electroanatomical mapping (NOGA, Biosense-Webster, Waterloo, Belgium) was performed during mononuclear cell isolation. Areas for cell injection were selected based on the localization of ischemia on SPECT. These areas were mapped in detail to evaluate local bipolar electrogram duration, amplitude and fragmentation. Mononuclear cells were injected in the ischemic area with the NOGA system. SPECT and electroanatomical mapping were repeated at 3 months. Holter monitoring was repeated at 3 and 6 months.. SPECT revealed a decrease in the number of segments with ischemia (3.5+/-2.5 vs. 1.1+/-1.0 at 3 months; P<0.01) and an increased left ventricular ejection fraction (44+/-13% vs. 49+/-17% at 3 months; P=0.02). The number of ventricular premature beats remained unchanged (10+/-24x10(2)/24h vs. 8+/-23x10(2)/24h at 3 months (P=NS) and 12+/-30x10(2)/24h at 6 months (P=NS)). At 3 months follow-up, bone marrow cell injection did not prolong electrogram duration (15.9+/-4.6 ms vs. 15.6+/-4.0 ms; P=NS), decrease electrogram amplitude (3.8+/-1.5 mV vs. 3.8+/-1.5 mV; P=NS), or increase fragmentation (2.0+/-0.5 vs. 1.9+/-0.4; P=NS).. Intramyocardial bone marrow cell injection does not increase the incidence of ventricular arrhythmias and does not alter the electrophysiological properties of the injected myocardium.

Topics: Aged; Angina Pectoris; Body Surface Potential Mapping; Bone Marrow Transplantation; Chronic Disease; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart Rate; Humans; Incidence; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Research Design; Stroke Volume; Tachycardia, Sinus; Tachycardia, Ventricular; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Premature Complexes

Intramyocardial injection of bone marrow cells has been proposed as a new therapeutic option for patients with chronic ischemic heart disease. We investigated whether autologous bone marrow-derived mononuclear cell injection into the myocardium of patients with drug-refractory ischemia reduces anginal symptoms, improves left ventricular (LV) function, increases myocardial perfusion, and alters the extent of scar tissue.. In 25 patients (mean age +/- SD, 64 +/- 10 y; 21 male) with drug-refractory angina pectoris (Canadian Cardiovascular Society [CCS] class III-IV), despite optimized medical therapy and without options for conventional revascularization, bone marrow was aspirated from the iliac crest. Mononuclear cell injections were targeted at myocardial regions with stress-induced ischemia on gated (99m)Tc-tetrofosmin SPECT. Anginal symptoms were reassessed at 3- and 6-mo follow-up. At baseline and 3-mo follow-up, gated (99m)Tc-tetrofosmin SPECT and (18)F-FDG SPECT were performed to assess LV function, LV volumes, myocardial perfusion (stress and rest, 17-segment model), and extent of scar tissue.. Mean CCS score improved from 3.4 +/- 0.6 at baseline to 2.3 +/- 0.6 at 3 mo (P < 0.01) and remained unchanged at 6 mo (2.3 +/- 0.6; P < 0.01 vs. baseline and P = not significant [NS] vs. 3 mo). Gated (99m)Tc-tetrofosmin SPECT demonstrated an increased LV ejection fraction (from 47.6% +/- 13.5% to 54.1% +/- 16.9%; P < 0.01) and a reduced LV end-systolic volume (from 81 +/- 68 mL to 75 +/- 70 mL; P < 0.01). Segmental regional wall thickening increased from 34% +/- 12% at baseline to 39% +/- 17% at 3-mo follow-up (P = 0.01). The number of segments with stress-inducible ischemia per patient decreased from 4.6 +/- 3.2 to 2.0 +/- 2.6 (P < 0.01). Both segmental stress and segmental rest score improved, although the improvement in stress score was more pronounced (decrease in segmental stress score 0.22 +/- 0.20 vs. decrease in segmental rest score 0.04 +/- 0.06; P < 0.01). Myocardial perfusion improved in 53% of the injected segments and in 13% of the noninjected segments (P < 0.01). The percentage of myocardial segments with some extent of scar remained unchanged at 3-mo follow-up (13% vs. 12%; P = NS).. Autologous bone marrow-derived mononuclear cell injection in patients with drug-refractory angina and chronic ischemia improves anginal symptoms, increases LV function, and predominantly enhances myocardial stress perfusion in injected segments, whereas the extent of myocardial scar tissue remains unchanged.

Topics: Aged; Angina Pectoris; Bone Marrow Transplantation; Chronic Disease; Drug Resistance; Fluorodeoxyglucose F18; Humans; Injections; Leukocytes, Mononuclear; Male; Middle Aged; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Ventricular Function, Left

When adenosine stress testing is performed, a vein is generally accessed in each arm. To determine whether the one-route infusion protocol, that is, infusion via one upper arm vein, is safe, myocardial perfusion imaging was performed during adenosine stress testing in patients with angina pectoris. Sixty-six consecutive patients (43 men, 68 +/- 11 years of age) with suspected coronary artery disease were enrolled in this study. For the stress test, adenosine was injected at 120 microg/kg/min for 6 minutes. Systolic blood pressure, diastolic blood pressure, and heart rate did not show any significant changes after injection of the adenosine and radioisotope (RI) tracer. Adverse events during infusion of the adenosine were seen in 42 (64%) patients and included chest discomfort/oppression in 17 (26%) and dyspnea/throat discomfort in 15 (23%). On the other hand, adverse events just after infusion of the RI tracer occurred in 5 (8%) patients and included chest oppression in 2 (3%) and dyspnea in 1 (2%). Almost all adverse events disappeared quickly without treatment. Therefore, we concluded that adenosine stress myocardial perfusion imaging using a one-route infusion protocol is safe and useful to do for patients unable to secure veins in both arms.

Topics: Adenosine; Adult; Aged; Aged, 80 and over; Angina Pectoris; Blood Pressure; Coronary Artery Disease; Heart; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sestamibi

Angina pectoris is a major symptom associated with myocardial ischemia. The aim of this study was to find whether stress myocardial perfusion imaging can independently predict mortality in patients with angina.. We studied 455 patients with stable angina pectoris by exercise or dobutamine stress (99m)Tc-tetrofosmin myocardial perfusion tomographic imaging. An abnormal finding was defined as a reversible or fixed perfusion abnormality. The endpoint during follow-up was death from any cause.. Mean age was 60+/-10 y. There were 266 men (58% of the patients). Myocardial perfusion was normal in 137 patients (30%). Perfusion abnormalities were reversible in 167 patients and fixed in 151 patients. During a mean follow-up of 6+/-1.7 y, 93 patients (20%) died. The annual mortality rate was 1.5% in patients with normal perfusion and 4.5% in patients with abnormal perfusion. Patients with a multivessel distribution of perfusion abnormalities had a higher annual death rate than patients with abnormalities in a single-vessel distribution (5.1% vs. 3.7%). In a multivariate analysis model, independent predictors of death were age (risk ratio, 1.05; 95% confidence interval [CI], 1.03-1.08), the male sex (risk ratio, 2.1; CI, 1.3-3.4), diabetes (risk ratio, 2.2; CI, 1.4-3.5), heart failure (risk ratio, 2.7; CI, 1.6-4.5), smoking (risk ratio, 1.7; CI, 1.1-2.6), reversible perfusion abnormalities (risk ratio, 1.9; CI, 1.1-2.8), and fixed perfusion abnormalities (risk ratio, 2; CI, 1.2-3.1).. Stress 99mTc-tetrofosmin myocardial perfusion imaging provides independent information for predicting mortality in patients with stable angina pectoris. Both reversible and fixed defects are associated with an increased risk of death. The extent of stress perfusion abnormalities is a major determinant of mortality. Patients with normal perfusion have a low mortality rate during long-term follow-up.

Topics: Adult; Aged; Angina Pectoris; Coronary Artery Disease; Disease-Free Survival; Female; Humans; Male; Middle Aged; Multivariate Analysis; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion; Prognosis; Proportional Hazards Models; Radiopharmaceuticals; Risk; Risk Factors; Time Factors; Tomography, Emission-Computed, Single-Photon

Increased lung uptake of thallium-201 in exercise myocardial perfusion imaging is a reliable marker of multivessel disease in patients with ischemic heart disease. This study investigated whether the lung-to-heart uptake ratio with techenetium-99m(99mTc)-tetrofosmin also provides valuable information to detect patients with multivessel disease.. Fifty-three consecutive patients (35 men, 18 women, mean age 66 +/- 11 years; single-vessel disease: 29, double-vessel disease: 16, triple-vessel disease: 8) with stable effort angina pectoris without prior myocardial infarction and 17 control subjects (12 men, 5 women, mean age 62 +/- 9 years) underwent exercise myocardial perfusion imaging with 99mTc-tetrofosmin and coronary angiography in January 2000 to December 2002. The lung-to-heart uptake ratio was calculated on an anterior projection before reconstruction of the exercise single photon emission computed tomographic images.. The mean lung-to-heart uptake ratio was 0.34 +/- 0.04, 0.38 +/- 0.07, 0.41 +/- 0.05, and 0.46 +/- 0.09, in patients with normal coronary, single-vessel disease, double-vessel disease, and triple-vessel disease, respectively. Significantly higher lung-to-heart uptake ratio was associated with more diseased vessels (p < 0.05). Multivessel disease could be detected with a sensitivity of 67% and a specificity of 74% if the cut-off point of the lung-to-heart uptake ratio was set as 0.4. Combining lung-to-heart uptake ratio with conventional myocardial perfusion imaging improved the sensitivity to detect multivessel disease to 83% and the specificity to 74%.. Lung-to-heart uptake ratio measured by exercise myocardial scintigraphy with 99mTc-tetrofosmin can provide clinically useful information to detect multivessel disease in patients with ischemic heart disease.

Topics: Angina Pectoris; Coronary Vessels; Exercise Test; Female; Heart; Humans; Lung; Male; Myocardial Infarction; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The severity of exercise-induced painful ischemia and its recovery after the disappearance of pain are unknown. The aim of this study was to investigate the difference in severity of ischemia at both exercise and postexercise between painful ischemia and painless ischemia. After injections of technetium-99m tetrofosmin at peak ergometer exercise and thallium-201 at 3 minutes postexercise, dual-isotope single photon emission tomography was performed in 78 patients with angiographically proven ischemic heart disease. The extent of ischemic areas (the number of areas), the depth of ischemia in the ischemic area (the severity score of ischemia) and the extension of ischemia toward long axis of the left ventricle (the number of left ventricular levels with ischemic areas in apical, middle, and basal levels) at both exercise and postexercise were compared on the basis of the presence of pain and a history of diabetes mellitus (DM). The symptoms improved within 3 minutes postexercise in all painful ischemia patients. Of 59 patients with reversible ischemia, except for 4 painful ischemia patients with DM, the extent and depth of ischemia at postexercise were more severe in 14 painful ischemia patients without DM and 13 painless ischemia patients with DM than 28 painless ischemia patients without DM (extent; 2.9 +/- 1.7 areas, 3.5 +/- 2.8 areas versus 1.4 +/- 1.8 areas, P = 0.005, depth; 3.8 +/- 3.1 scores, 5.8 +/- 5.4 scores versus 1.9 +/- 3.0 scores, P = 0.0084, respectively) despite a comparable severity of ischemia at peak exercise (extent; 5.4 +/- 2.6 areas, 6.0 +/- 2.4 areas versus 4.3 +/- 3.3 areas, depth; 9.3 +/- 5.7 scores, 10.7 +/- 7.3 scores and 7.5 +/- 8.1 scores, all NS). The extension of ischemia toward long-axis of the left ventricle at both peak exercise and postexercise was more severe in the former 2 groups than the latter group (peak exercise; 2.4 +/- 0.6 levels, 2.5 +/- 0.7 levels versus 1.9 +/- 0.8 levels, P = 0.0263, postexercise: 1.8 +/- 0.7 levels, 1.5 +/- 0.9 levels versus 0.8 +/- 0.8 levels, P = 0.0014, respectively). The presence of chest pain is related to the extension of ischemia toward long-axis of the left ventricle, and the disappearance of pain was not related to the recovery of ischemia.

Topics: Aged; Angina Pectoris; Exercise; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Recovery of Function; Severity of Illness Index; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Transmyocardial laser revascularization is a new technique that improves symptoms in patients with refractory angina not amenable to conventional revascularization. The aim of this study was to assess whether transmyocardial laser revascularization produces changes in innervation, perfusion scintigraphy, or both that could explain the benefit to patients.. Sixteen patients (12 men and 4 women; mean age, 60 +/- 8 years) with coronary artery disease were studied. Transmyocardial laser revascularization was performed in 39 myocardial areas supplied by a stenotic vessel. A technetium 99m-labeled tetrofosmin stress-rest tomographic scan and iodine 123-labeled metaiodobenzylguanidine planar scans were performed before and after transmyocardial laser revascularization (3 and 12 months later) to evaluate myocardial perfusion and innervation. Stress and rest perfusion images were quantified on a polar map. Ischemia uptake was also defined as the difference between rest and stress uptake for each area. Innervation planar images were visually analyzed and semiquantified.. A significant decrease in angina class from baseline was observed at 3, 6, and 12 months after transmyocardial laser revascularization (P <.005). A significant decrease in ischemia uptake was also found between the pre-transmyocardial laser revascularization and the post-transmyocardial laser revascularization studies in treated areas (P <.001). A significant improvement in stress myocardial perfusion at 3 and 12 months after transmyocardial laser revascularization was only found in treated areas that were considered ischemic in the pre-transmyocardial laser revascularization study (P <.05). At 3 months, a significant myocardial innervation worsening was observed in treated areas (P <.001), with partial recovery at 12 months (P <.05).. The transmyocardial laser revascularization mechanism involves both perfusion improvement and denervation, mainly at 3 months, that partially recovered at 12 months.

Topics: 3-Iodobenzylguanidine; Angina Pectoris; Female; Humans; Iodine Radioisotopes; Laser Therapy; Male; Middle Aged; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals

We report the estimation of left ventricular systolic pressure (LVSP) by a left ventricular (LV) volume-time curve obtained from electrocardiogram (ECG) gated 99mTc-tetrofosmin single photon emission computed tomography (SPECT) using quantitative gated SPECT (QGS). LVSP was calculated based on the following parameters: LV volumes, velocity and acceleration of LV contraction, aortic valve area and density of blood. The first three parameters can be derived from ECG gated SPECT. In 16 patients, the LV volume-time curve was obtained from ECG gated SPECT by using QGS. LVSP was estimated by the above-mentioned theory. The values of estimated peak LVSP were compared with those measured from a pressure transducer. There was a correlation between the values of peak LVSP estimated by the LV volume-time curve and those measured by pressure transducer (r=0.69, P<0.01). Using QGS, LVSP and the systolic LV pressure-volume relationship could be estimated by the LV volume-time curve.

Topics: Algorithms; Angina Pectoris; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Models, Cardiovascular; Myocardial Infarction; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Ventricular Function, Left; Ventricular Pressure

Administration of dipyridamole produces angina and ST depression in 20%-30% and 6%-34% of patients, respectively. This study aimed to evaluate the clinical implications of the presentation of angina and/or ST depression during the administration of dipyridamole in the study of coronary heart disease by myocardial perfusion SPECT (MPS).. The study population is constituted by 593 consecutive patients without left branch block or ventricular pacemaker rhythm who were referred to our service to undergo MPS with dipyridamole. A SPECT was performed after the administration of 99mTc-tetrosfosmine and drug stimulation with dipyridamole (0.142 mg/kg/min for 4 minutes). A coronariography was performed in 338 patients (57%). The frequency of clinical and electrical positivity and their relationship with the MPS and the coronariography were studied.. The rate of angina and ST depression was 32% (n = 190) and 10% (n = 58), respectively. Myocardial perfusion defects were observed in 465 patients (78%), and signs of scintigraphic ischemia in 311 (52%). The patients with ST depression presented a higher frequency of perfusion defects (93% vs 76%, p = 0.0012) and scintigraphic ischemia (89% vs 49%, p < 0.0001). In addition, perfusion defects in more than one territory were observed in these patients in a higher percentage (53% vs 34%, p = 0.0036). Among the patients who underwent cardiac catheterization, those who had a ST depression had a greater extension of coronary heart disease (1.8 +/- 1.2 vs 1.3 +/- 1.0 diseased vessels, respectively. p = 0.0100) and a higher frequency of multivessel disease (61% vs 43%, p = 0.0380). Those patients who had clinical positivity showed a scintigraphic ischemia more frequently (66% vs 47%, p < 0.0001), however no statistically significant differences were observed between the presence of patients with perfusion defects or in the extension of these defects as well as in the number of diseased vessels in the coronariographic study.. During the administration of dipyridamole, the ST depression is associated with more frequent scintigraphic ischemia, larger extension of perfusion defects and more diseased vessels. The appearance of angina is associated with scintigraphic ischemia, but it is not necessarily associated with the extension of perfusion defects or greater number of diseased vessels.

Topics: Angina Pectoris; Convalescence; Coronary Angiography; Coronary Circulation; Coronary Disease; Dipyridamole; Electrocardiography; False Negative Reactions; False Positive Reactions; Heart; Humans; Myocardial Infarction; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Patients with permanent ventricular pacemakers (PP) are a difficult subgroup to assess in the study of coronary artery disease. The objective of this study was to evaluate the diagnostic value of the myocardial perfusion scintigraphy with 99mTC-Tetrofosmin (Tc-Tf) and stimulus with dipyridamole in patients with PP and suspected coronary artery disease.. Fourteen patients with suspected coronary artery disease and without structural cardiopathy, who underwent Tc-Tf and cardiac catheterization, were studied retrospectively. Sensitivity, specificity, predictive values and Kappa index were calculated for the diagnosis of coronary artery disease, multivessel disease, and for each one of the coronary arteries (left anterior descending, right coronary, and circumflex). In addition, the correlation between the number of territories with perfusion defects and the number of diseased vessels was studied.. In regards to the diagnosis of coronary artery disease, sensitivity, specificity, positive predictive value, negative predictive value and the Kappa index were 100%, 50%, 83%, 100% and 0.55, respectively. For multi-vessel disease, these values were 83%, 64%, 64%, 83% and 0.43 respectively. The correlation coefficient between the number of territories with perfusion defects and the number of diseased vessels was 0.61 (p = 0.02). In the diagnosis of anterior descending disease, sensitivity and specificity were 83% and 88% respectively. For the right coronary artery, these values were 100% and 44% and for the circumflex artery 38% and 83%, respectively.. In patients with PP and suspected coronary artery disease, myocardial perfusion scintigraphy with Tc-Tf and stimulus with dipyridamole is of great value in the diagnosis of coronary artery disease and in the assessment of its extension.

Topics: Aged; Aged, 80 and over; Angina Pectoris; Arrhythmias, Cardiac; Cardiac Catheterization; Comorbidity; Coronary Angiography; Coronary Circulation; Dipyridamole; Female; Humans; Male; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Pacemaker, Artificial; Predictive Value of Tests; Radiopharmaceuticals; Risk Factors; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

To assess whether 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) imaging can identify previous ischemic areas, BMIPP SPECT was performed in patients with acute chest pain to compare its findings with those of technetium-99m-tetrofosmin (tetrofosmin) SPECT and coronary angiography.. Basic studies indicate that BMIPP can identify previous ischemia as reduced tracer uptake.. This study prospectively enrolled 111 consecutive patients with acute chest pain without myocardial infarction. Tetrofosmin SPECT was performed at rest within 24 h after the last episode of chest pain. Coronary angiography and BMIPP SPECT were also performed on the following day.. Sixty-four of the 87 patients with coronary stenosis or spasm showed BMIPP abnormalities corresponding to the areas of coronary abnormalities (sensitivity 74%), whereas only 33 of them showed perfusion abnormalities (sensitivity 38%) (p < 0.001). Of 24 patients [corrected] without coronary stenosis or spasm, 22 showed normal BMIPP SPECT (specificity = 92%) [corrected] and 23 showed normal tetrofosmin SPECT (sensitivity = 96%) [corrected]. Coronary stenosis was more often seen in the group with abnormal tetrofosmin/abnormal BMIPP (82%) and with normal tetrofosmin/abnormal BMIPP (69%) than in the group with normal tetrofosmin/normal BMIPP (36%) (p < 0.05). Coronary spasm was observed more often in the group with abnormal tetrofosmin/abnormal BMIPP (83%) and with normal tetrofosmin/abnormal BMIPP (90%) than in the group with normal tetrofosmin/normal BMIPP (27%) (p < 0.05). The extent and severity scores of tetrofosmin and BMIPP in the patients with organic stenosis were significantly higher than those of patients with no organic stenosis or spasm (p < 0.0001).. These data indicate that BMIPP SPECT may specifically identify previous ischemic lesions due to coronary stenosis or spasm in patients with acute chest pain.

Topics: Aged; Angina Pectoris; Chest Pain; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Tomography, Emission-Computed, Single-Photon

This study was designed to evaluate the clinical usefulness of delayed exercise images in 99mTc-tetrofosmin (TF) myocardial SPECT in the diagnosis of vasospastic angina pectoris. We studied 30 patients with vasospastic angina, 10 of 30 patients (group A) had both effort and rest angina, 20 of 30 patients (group B) had rest angina. A 370 MBq of TF was intravenously injected at peak exercise, and initial (EX-I) and delayed exercise (EX-D) images were obtained at 30 min and 180 min after the injection. An additional 740 MBq of TF was intravenously reinjected after EX-D image acquisition, and rest images were obtained 30 min after the reinjection. The left ventricular wall was divided into 9 segments. Regional myocardial uptakes of TF were scored by 4-point defect score (0 = normal, 1 = mildly reduced, 2 = moderately reduced, and 3 = severely reduced). Total defect score (TDS) was calculated from the sum of defect scores in 9 segments. Reverse redistribution (RR) was defined as increase of more than 2 in TDS on EX-D images. In group A, 4 of 10 cases (40%) showed decreased uptake on EX-I images, 6 of 10 cases (60%) revealed RR on EX-D images, and none of the patients showed decreased uptake on rest images. In group B, no one showed decreased uptake on EX-I and rest images, 11 of 20 cases (55%) revealed RR on EX-D images. The mean +/- SD of TDS were 2.9 +/- 3.4, 5.1 +/- 4.5, 0.5 +/- 0.5 on EX-I, EX-D, rest images in group A, and serially 0.4 +/- 0.5, 3.3 +/- 3.6, 0.4 +/- 0.5 in group B. Regional wall motion abnormality was reduced in regions with RR. RR on EX-D images may reflect ischemic damaged but viable myocardium in vasospastic angina. The clinical usefulness of exercise-rest TF imaging in detection of organic coronary artery disease has been well established. Therefore, exercise-rest TF imaging with additional delayed exercise image could evaluate not only organic coronary artery disease but also coronary artery vasospasm.

Topics: Aged; Angina Pectoris; Coronary Vasospasm; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon

To evaluate the effect of left ventricular (LV) size on the calculation of LV function from gated myocardial SPECT with Emory and Cedars-Sinai programs, we performed 99mTc-tetrofosmin gated SPECT on 49 patients with ischemic heart disease. End-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were semi-automatically calculated by each program. All patients underwent left ventriculography (LVG) within 3 months before and after the SPECT study. We grouped the patients into 22 with a calculated ESV obtained from LVG of over 50 ml (group A) and 27 with an ESV value of 50 ml or below (group B). We then compared the ESV values from gated SPECT with those from LVG in each group. In group A, the ESV from both Emory and Cedars-Sinai programs similarly correlated well with those from LVG (r = 0.92 and r = 0.93, respectively), but in group B, the ESV calculated from the Cedars-Sinai program correlated less with those from LVG (r = 0.53) than those from the Emory program did (r = 0.70). The calculated LV volumes had more errors in the Cedars-Sinai program than in the Emory program, when a patient had a small heart.

Topics: Adult; Aged; Angina Pectoris; Automation; Diastole; Female; Gated Blood-Pool Imaging; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Regression Analysis; Systole; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

We compared dipyridamole technetium-99m (Tc-99m) tetrofosmin and thallium-201 (Tl-201) single-photon emission computed tomographic (SPECT) imaging with respect to the detection rate of perfusion abnormalities in 26 patients with angiographic coronary artery disease (CAD).. Experimental studies have shown that myocardial extraction of Tc-99m tetrofosmin is lower than that of Tl-201 at high flow rates, resulting in less severe defects with vasodilator stress. It is uncertain whether this results in a lower sensitivity than Tl-201 for detecting coronary stenoses with vasodilator stress in patients.. Twenty-six patients with CAD underwent both dipyridamole Tl-201 and Tc-99m tetrofosmin SPECT. Tomographic images were scored for initial defects and the presence of reversibility. Defect magnitude was computer quantitated.. Of the 26 patients, 25 had defects on both Tl-201 and Tc-99m tetrofosmin SPECT images. Of 340 segments analyzed, 102 had defects by Tl-201 and 92 by Tc-99m tetrofosmin (p = NS). Whereas Tl-201 detected 27 fixed defects in 12 patients, Tc-99m tetrofosmin identified 37 fixed defects in 14 patients (p = NS). In contrast, Tl-201 identified more reversible and partially reversible defects than did Tc-99m tetrofosmin (89 vs. 55, p = 0.002). The average defect magnitude (percent normal) was similar for defects concordantly graded as fixed (38 +/- 3.0% for Tl-201 vs. 42 +/- 4% [mean +/- SEM] for Tc-99m tetrofosmin, p = NS). The average defect magnitude for defects concordantly graded as completely reversible was significantly more severe on Tl-201 than on Tc-99m tetrofosmin (49 +/- 3% vs. 58 +/- 3%) SPECT images. A significantly greater defect magnitude for Tl-201 was also found for defects concordantly classified as partly reversible (30 +/- 4% for Tl-201 vs. 45 +/- 5% for Tc-99m tetrofosmin).. With dipyridamole stress, 1) at least one defect was seen on both Tl-201 and Tc-99m tetrofosmin SPECT images; 2) Tc-99m tetrofosmin SPECT identified fewer reversible defects than did Tl-201, but showed a similar number of fixed defects; 3) the magnitude of reversible defects seen on Tc-99m tetrofosmin images was less, whereas fixed defects were similar for both tracers; 4) reversible defects seen on Tl-201 and not on Tc-99m tetrofosmin SPECT images were predominantly regions perfused by mild coronary stenoses.

Topics: Adult; Aged; Angina Pectoris; Blood Pressure; Chi-Square Distribution; Coronary Angiography; Coronary Circulation; Coronary Disease; Dipyridamole; Electrocardiography; Heart Rate; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has been considered potentially useful for acute chest pain imaging. Tetrofosmin also has favorable biokinetics with reported rapid liver clearance, 5 min poststress and 30-45 min post-rest injection. Since comparable data are not available, the effect of time on liver clearance was evaluated in patients with acute chest pain.. One hundred six patients received an intravenous injection of 25-30 mCi 99mTc-tetrofosmin to evaluate acute chest pain. SPECT imaging was performed 15-120 min after injection of the tracer. Patient images were grouped according to the time of acquisition after acute injection: 15-30 min, 31-45 min, 46-60 min, 61-90 min and > 90 min. Quantitative analysis was performed of a similar anterior projection for each patient consisting of 6 X 6-pixel region of interest over the myocardium and adjacent liver. Average counts per pixel were determined and a heart/liver (H/Li) ratio was calculated.. The mean H/Li ratio was < 1.0 for patient images acquired 15-45 min after injection, and > 1.0 for patient images acquired after 45 min. The difference was statistically significant (p < 0.05).. Quantitative analysis suggests that the optimal imaging time should be at least 45 min after the injection of 99mTc-tetrofosmin to allow adequate liver clearance before image acquisition of acute chest pain syndromes.

Topics: Aged; Angina Pectoris; Evaluation Studies as Topic; Female; Heart; Humans; Image Processing, Computer-Assisted; Injections, Intravenous; Liver; Male; Metabolic Clearance Rate; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon

99Tcm-tetrofosmin is a new myocardial perfusion agent with the advantage that it can be reconstituted at room temperature. Because two separate injections are required for rest and stress images, a separate-day imaging protocol with one injection each day would be optimal in terms of image quality. From the logistical point of view, a 1 day protocol may be more convenient for the majority of those referred as outpatients. The main aim of this study was to determine whether the detection of myocardial ischaemia would be impeded by the use of a 1 day protocol instead of a 2 day protocol. A secondary aim was to establish the relative diagnostic accuracy of the two imaging strategies. 99Tcm-tetrofosmin SPET imaging was performed in 157 patients. Sixty-nine (44%) patients were administered 250 MBq (7 mCi) 99Tcm-tetrofosmin at rest followed 4 h later by 750 MBq (21 mCi) during stress (the 1 day protocol), whereas 88 (56%) patients had rest and stress imaging studies on two separate days, receiving a 500 MBq (14 mCi) dose of 99Tcm-tetrofosmin on each occasion (the 2 day protocol). With the 1 day protocol, 135 of 621 (22%) abnormal segments (i.e. both reversible and persistent defects) were observed, compared with 195 of 792 (25%) segments with the 2 day protocol. Also, the occurrence of reversible defects only did not differ between the two protocols (both 9%). The sensitivity for the detection of coronary artery disease was 83 and 90% for the 1 and 2 day protocols respectively. We conclude that the 1 and 2 day protocols provide similar scintigraphic information and are equally sensitive and specific for the detection of coronary artery disease. Therefore, the imaging protocol can be adjusted as appropriate for the patient in question.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Chest Pain; Coronary Angiography; Coronary Vessels; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion; Radiopharmaceuticals; Rest; Sensitivity and Specificity; Time Factors; Tomography, Emission-Computed, Single-Photon