Impaired Coronary Flow Reserve Is the Most Important Marker of Viable Myocardium in the Myocardial Segment-Based Analysis of Dual-Isotope Gated Myocardial Perfusion Single-Photon Emission Computed Tomography.
10.3348/kjr.2014.15.2.277
- Author:
Won Woo LEE
1
;
Young SO
;
Ki Bong KIM
;
Dong Soo LEE
Author Information
1. Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea.
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Myocardium;
Tissue viability;
Ischemia;
Coronary artery bypass grafting;
Single-photon emission-computed tomography
- MeSH:
Adult;
Aged;
Analysis of Variance;
Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography/*methods;
Coronary Artery Bypass;
Coronary Artery Disease/physiopathology/*radionuclide imaging/surgery;
Coronary Circulation/*physiology;
Coronary Disease/radionuclide imaging/surgery;
Female;
Humans;
Male;
Middle Aged;
Myocardial Contraction/physiology;
Myocardium;
Nitriles/diagnostic use;
Stroke Volume/physiology;
Technetium/diagnostic use;
Ventricular Function, Left/physiology
- From:Korean Journal of Radiology
2014;15(2):277-285
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), 201Tl perfusion status at rest, 201Tl 24 hours redistribution and systolic wall thickening of 99mTc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery. MATERIALS AND METHODS: A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 +/- 8 standard in years) who underwent both pre- and 3 months post-CABG myocardial SPECT. We analyzed 17 myocardial segments per patient. Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system. Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG. RESULTS: The left ventricular ejection fraction (LVEF) significantly increased from 37.8 +/- 9.0% to 45.5 +/- 12.3% (p < 0.001) in 22 patients who had a pre-CABG LVEF lower than 50%. Among 590 myocardial segments in the re-vascularized area, 115 showed abnormal wall motion before CABG and 73.9% (85 of 115) had wall motion improvement after CABG. In the univariate analysis (n = 115 segments), stress/rest reversibility (p < 0.001) and 201Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement. However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001). CONCLUSION: Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.
