Prediction of functional improvement of ischemic myocardium with (123I-BMIPP SPECT and 99mTc-tetrofosmin SPECT imaging: a study of patients with large acute myocardial infarction and receiving revascularization therapy.

Abstract

BACKGROUND:

(18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) is assumed to be the most useful method of evaluating the viability of the myocardium, but its use is limited by the need for a cyclotron. In the present study, the ability of a combination of (99m)Tc-tetrofosmin (TF) and (123)I-beta-methyliodophenyl pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT), a combination of (18)F-FDG PET and (123)I-BMIPP SPECT, and a combination of (18)F-FDG PET and (99m)Tc-TF SPECT were compared to predict functional improvement of ischemic myocardium after a large acute myocardial infarction (AMI).

METHODS AND RESULTS:

Ten patients with large AMI were studied by (99m)Tc-TF SPECT, (123)I-BMIPP SPECT and (18)F-FDG PET within 3 weeks. Six months later, (99m)Tc-TF imaging was performed. All patients underwent successful revascularization, and had no restenosis. Regional tracer uptake was scored using a 4-point scale in 20 segments of the SPECT and PET images. When the defect score of (123)I-BMIPP SPECT exceeded the defect score of (99m)Tc-TF SPECT or (18)F-FDG PET by 1 point or more, and when the defect score of (99m)Tc-TF SPECT exceeded the defect score of (18)F-FDG PET by 1 point or more, the segment was considered to show mismatching. When the defect score was the same in 2 tracers, the segment was considered to show matching. (99m)Tc-TF imaging at 3 weeks and 6 months used quantitative gated SPECT (QGS) to score wall motion using a 6-point scale (-1= dyskinesis, 0= akinesis, 1= severe hypokinesis, 2= moderate hypokinesis, 3= mild hypokinesis, and 4= normokinesis). The sensitivity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 61%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 94%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 76%. The specificity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 83%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 40%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 49%. The accuracy of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 70%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 71%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 63%.

CONCLUSION:

The combination of (123)I-BMIPP and (99m)Tc-TF imaging is a practical modality for predicting the functional improvement of ischemic myocardium after a large AMI.

• Authors: Hidenori Seki, Takuji Toyama, Kyosuke Higuchi, Shu Kasama, Tetsuya Ueda, Ryotaro Seki, Takashi Hatori, Keigo Endo, Masahiko Kurabayashi
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 69 Issue 3 Pg. 311-9 (Mar 2005) ISSN: 1346-9843 [Print] Japan
• PMID: 15731537 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Drug Combinations
• Fatty Acids
• Iodine Radioisotopes
• Iodobenzenes
• Organophosphorus Compounds
• Organotechnetium Compounds
• Radiopharmaceuticals
• iodofiltic acid
• technetium tc-99m tetrofosmin

Topics

• Aged
• Drug Combinations
• Fatty Acids
• Female
• Humans
• Iodine Radioisotopes
• Iodobenzenes
• Male
• Middle Aged
• Myocardial Infarction (pathology, surgery)
• Myocardial Ischemia (diagnosis, surgery)
• Myocardial Revascularization
• Organophosphorus Compounds
• Organotechnetium Compounds
• Predictive Value of Tests
• Radiopharmaceuticals
• Sensitivity and Specificity
• Severity of Illness Index
• Tomography, Emission-Computed, Single-Photon (methods)
• Treatment Outcome