technetium-tc-99m-tetrofosmin and Cardiomyopathy--Dilated

To investigate myocardial fatty acid metabolism and its relationship with left ventricular (LV) function and perfusion in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM).. Thirty-nine patients with cardiomyopathies (58 +/- 14 y), comprising 15 DCM and 24 HCM, and 9 age-matched healthy controls were studied with 123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99mTc-tetrofosmin (TF) electrocardiographically gated SPECT. As parameters of myocardial fatty acid metabolism, the heart-to-mediastinum ratio (H/M) and global washout of BMIPP were calculated from early and delayed planar images, while regional BMIPP uptake and washout were calculated from SPECT. In TF study, the H/M (H/M-TF) and LV ejection fraction (LVEF) were calculated as global parameters of perfusion and function, while regional TF uptake and wall thickening index were calculated as regional parameters of perfusion and function using the Quantitative Gated SPECT software. The differences in the parameters and the correlations between the parameters from the 2 studies were investigated by one-way ANOVA and multiple linear regression analysis.. BMIPP uptake was decreased (p < 0.05), and its washout was increased (p < 0.05) in DCM and HCM. In multiple linear regression analysis, global BMIPP parameters showed no significant correlation with LVEF (p > 0.05), but showed a significant correlation with H/M-TF (p < 0.05) in DCM and HCM. According to the partial correlation coefficient, early H/M was the only significant factor (p < 0.05) for predicting H/M-TF in DCM and HCM. Multiple linear regression analysis on regional parameters showed regional BMIPP parameters had no correlation with regional function (p > 0.05) but had a significant correlation with regional perfusion (p < 0.0001) in DCM. In HCM, regional BMIPP parameters showed significant multiple linear correlations with both regional function (p < 0.005) and perfusion (p < 0.0001). According to the partial correlation coefficients, delayed regional BMIPP uptake was the most significant factor for predicting regional function in HCM, while early regional BMIPP uptake was the only or the most significant factor for predicting regional perfusion in DCM and HCM, respectively.. In DCM, BMIPP uptake and washout could not reflect LV function. In HCM, regional delayed BMIPP uptake might be useful for evaluating regional function. In DCM and HCM, early BMIPP uptake might be largely determined by myocardial perfusion.

Topics: Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Electrocardiography; Fatty Acids; Female; Gated Blood-Pool Imaging; Heart Ventricles; Humans; Iodobenzenes; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Ventricular Dysfunction, Left

This study aimed to clarify the relationship between severity of conduction delay in the left ventricle and myocardial uptake of (99m)Tc-tetrofosmin (TF) in dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB).. Thirty-two DCM patients with LBBB underwent electrocardiography and (99m)Tc-TF myocardial single-photon emission computed tomography (SPECT). SPECT images were acquired at 30 min (early images) and 3 h (late images) after injection. We calculated the total defect score (TDS) using a 20-segment model with a 5-point scoring system. The TDS in early and late images was defined as the summed early score (SES) and summed late score (SLS), respectively. On early images, 29 of 32 patients (91%) had decreased tracer uptake in the septum. All patients showed a decreased tracer uptake in the septum on late images. A significant correlation was observed between TDS (both SES and SLS) and QRS duration, with SLS showing an excellent correlation (SES: r = 0.554, P < 0.001; SLS: r = 0.779, P < 0.0001).. These findings suggest that in DCM patients with LBBB, hypoperfusion and myocardial damage in the septum might occur in accordance with an increase in the QRS duration.

Topics: Bundle-Branch Block; Cardiomyopathy, Dilated; Female; Heart Conduction System; Heart Rate; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Tomography, Emission-Computed, Single-Photon

To prospectively compare the left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) obtained from gated perfusion single photon emission computed tomography (GSPECT) with those obtained from cardiac magnetic resonance imaging (MRI) in patients with idiopathic dilated cardiomyopathy (IDC). Twenty-one patients with IDC (6 females) with a median age of 45 years (range 17-65) were scheduled for (99m)Tc-tetrofosmin-GSPECT and MRI within a 3 h interval. In both methods LV volumes were analyzed with the Simpson method. Both GSPECT and MRI were successfully completed in 90% of patients. Close linear correlations were observed between the two methods in LVEDV (R = 0.918; P < 0.001) and LVESV (R = 0.946; P < 0.001), but correlations were significantly weaker in LVEF (R = 0.323; P = 0.082). LVEDV and LVESV were smaller in GSPECT than in MRI (161 ± 73 vs. 214 ± 87 ml, P < 0.001, and 116 ± 64 vs. 138 ± 72 ml, P < 0.001, respectively). In 4 patients (21%) the LVEDV index was considered normal by GSPECT and increased by MRI, if MRI-derived normal values were used. No difference was found between GSPECT and MRI when LVEF(MRI) was ≤ 40%, but GSPECT showed smaller LVEF when LVEF(MRI) was over 40% (33 ± 11 vs. 50 ± 5%; P < 0.05). The finding of increased LVEDV in GSPECT is reliable compared with MRI. However, LV volumes were underestimated by GSPECT and no direct comparisons can be made between methods in follow up studies. Abnormal results should be confirmed by another imaging modality, such as MRI, if these findings have therapeutic consequences.

Topics: Adolescent; Adult; Aged; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Cardiomyopathy, Dilated; Female; Finland; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Stroke Volume; Ventricular Function, Left; Young Adult

Topics: Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Cardiomyopathy, Dilated; Humans; Magnetic Resonance Imaging, Cine; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Stroke Volume; Ventricular Function, Left

The purpose of this study was to determine whether myocardial imaging using technetium-99m tetrofosmin can noninvasively identify myocardial damage in hypertrophic cardiomyopathy (HC). The study consisted of 10 patients with apical HC, 10 with asymmetric septal HC (ASH) group, 5 with dilated cardiomyopathy (DC)-like group, and 20 healthy subjects. With use of a bull's-eye map of single-photon emission computed tomographic imaging, the total defect score of tetrofosmin and the washout rate were assessed in 5 segments (septum, and anterior, lateral, and inferior walls, and apex) of the left ventricle. A localized increase in defect score and washout rate was observed in the hypertrophied region in the group with apical HC. An increased washout rate was observed in the ASH group regardless of hypertrophy, suggesting that tetrofosmin retention by the mitochondria was impaired in the entire left ventricular wall. The washout rate was further increased at all segments in the DC-like group versus the ASH group. Tetrofosmin retention by mitochondria was impaired in the entire left ventricular wall in the ASH group and was increased further in the DC-like group. The dysfunction of myocardial cells was limited to the hypertrophied region in the apical HC group.

Topics: Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Echocardiography; Female; Heart; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Stroke Volume; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

The objective of this study was to clarify the relationship between cardiac sympathetic nervous function (CSNF) and left ventricular (LV) function and perfusion in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM).. Thirty-eight cases (32 males, 6 females; mean age, 56 +/- 15 y), consisting of 5 healthy control subjects, 15 patients with DCM, and 18 patients with HCM, were studied with (123)I-metaiodobenzylguanidine (MIBG) and (99m)Tc-tetrofosmin SPECT. CSNF was evaluated from cardiac uptake and washout of MIBG, whereas LV perfusion and function were evaluated from tetrofosmin uptake and wall thickening on electrocardiographically gated SPECT. As quantitative parameters of global cardiac MIBG uptake and washout, the heart-to-mediastinum ratio (H/M) and percentage washout were calculated from early and delayed planar images. As quantitative regional parameters, the regional uptake and percentage washout of MIBG were calculated from SPECT images dividing the left ventricle into 12 segments. In the tetrofosmin study, the H/M and LV ejection fraction were calculated as the parameters of global LV perfusion and function. As quantitative regional parameters, the regional uptake and wall thickening were also calculated for the 12 myocardial segments using the quantitative gated SPECT software. Multiple linear regression analysis was performed to investigate the correlations between the parameters from the 2 studies.. In DCM and HCM, multiple linear regression analysis of the regional parameters showed significant correlations between LV function and CSNF (P < 0.0001) and between LV perfusion and CSNF (P < 0.0001). According to the partial correlation coefficients, washout and early uptake of MIBG were the most significant factors for predicting LV function and LV perfusion, respectively.. In cardiomyopathies, CSNF was closely related to LV function. The quantitative parameters of MIBG washout could reflect cardiac functional impairment. Early MIBG uptake might be determined by myocardial perfusion in cardiomyopathies.

Topics: 3-Iodobenzylguanidine; Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Coronary Circulation; Electrocardiography; Female; Heart; Humans; Iodine Radioisotopes; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sympathetic Nervous System; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

The purpose of this study was to compare left ventricular (LV) volume and ejection fraction (LVEF) measurements obtained with electrocardiographic gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (GS-MPI) with those obtained with gated SPECT cardiac blood-pool imaging (GS-pool). Fifteen patients underwent GS-MPI with technetium-99m-tetrofosmin and GS-pool with technetium-99m-erythrocyte, within a mean interval of 8 +/- 3 days. Eight patients had suspected dilated cardiomyopathy and seven patients had angiographically significant coronary artery disease. End-diastolic volume (EDV), end-systolic volume (ESV) and LVEF measurements were estimated from GS-MPI images by means of Cedars-Sinai automatic quantitative program and from GS-pool images by the threshold technique. Mean differences between GS-MPI and GS-pool in EDV, ESV and LVEF measurements were -2.8 +/- 10.5 ml [95% confidence interval (CI): -8.6 +/- 3.0 ml], 2.6 +/- 7.3 ml (CI: -1.4 +/- 6.6 ml) and -2.3 +/- 5.1% (CI: -5.1 +/- 0.6%), respectively. No significant difference in the mean differences from 0 was found for EDV, ESV or LVEF measurements. Bland-Altman plots revealed no trend over the measured LV volumes and LVEF. For all parameters, regression lines approximated lines of identity. The excellent agreement between GS-MPI and GS-pool measurements suggests that, for estimation of LV volumes and LVEF, these two techniques may be used interchangeably and measurements by one method can serve as a reference for the other.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Coronary Disease; Databases, Factual; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Phantoms, Imaging; Radiopharmaceuticals; Reference Values; Technetium; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

First-pass radionuclide angiography (FPRNA) was performed with the new myocardial perfusion agent 99mTc-1,2,bis[bis(2-ethoxyethyl)phosphino] ethane (99mTc-PPN 1011) on stress and at rest. One hour after that, myocardial perfusion was counted by 99mTc-PPN 1011 SPECT. Left ventricular ejection fraction (LVEF) obtained by FPRNA correlated with that by multigated image with 99mTc-HSAD (r = 0.94, n = 11). The reduction of left ventricular function under the exercise (delta LVEF) and the increase of severity score (delta Severity score) have a good relation (r = 0.88) in 7 patients with prior myocardial infarction. Thus 99mTc-PPN 1011 appears to be an ideal radiopharmaceutical for evaluation of ventricular function and myocardial perfusion.

Topics: Aged; Cardiomyopathy, Dilated; Coronary Circulation; Exercise Test; Heart; Humans; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Stroke Volume; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left; Ventriculography, First-Pass