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Identification of viable myocardium in patients with chronic coronary artery disease using rest-redistribution thallium-201 tomography: Optimal image analysis (80 visite)

Pace L, Perrone-Filardi P, Mainenti PP, Cuocolo A, Vezzuto P, Prastaro M, Varrone A, De Luca G, Soricelli A, Betocchi S, Chiariello M, Salvatore M

J Nucl Med (ISSN: 0161-5505, 1535-5667, 1535-5667electronic), 1998 Nov; 39(11): 1869-1874.

Tipo di articolo: Journal Article,

Impact factor: 3.064

Impact factor a 5 anni: 5.331


Parole chiave: Myocardial Viability, Thallium-201, Thresholds, Thallium 201, Adult, Aged, Article, Cell Viability, Clinical Article, Controlled Study, Coronary Artery Disease, Diagnostic Accuracy, Echocardiography, Female, Heart Ejection Fraction, Heart Muscle, Heart Muscle Revascularization, Human, Image Analysis, Priority Journal, Prognosis, Single Photon Emission Computer Tomography, Statistical Analysis, Validation Process, Case-Control Studies, Coronary Disease, Image Processing, Computer-Assisted, Middle Aged, Myocardial Revascularization, Roc Curve, Sensitivity And Specificity, Thallium Radioisotopes, Emission-Computed, Single-Photon,

Url: http://www.scopus.com/inward/record.url?eid=2-s2.0-0031742139&partnerID=40&md5=430c757df72ee8d3be6fd24d5ed7408b

With the widely used 50% threshold, sensitivity is high, but specificity is low in detecting viable myocardium on Tl-201 SPECT, In this study, we sought to identify the best threshold for semiquantitative Tl-201 analysis, Methods: Rest-redistribution Tl-201 SPECT was performed in 46 patients with chronic coronary artery disease before and after myocardial revascularization, Regional function was evaluated by two-dimensional echocardiography before and after myocardial revascularization using a 3-point scale (1 = normal, 2 = hypokinetic, 3 = a/dyskinetic), Myocardial segments with abnormal systolic function were defined as viable if the systolic function score decreased greater than or equal to 1 after myocardial revascularization, A second group of 12 patients with chronic coronary artery disease constituted the validation population. Sensitivity-specificity curves, as well as receiver operating characteristic curves, for rest and redistribution images were generated by varying the Tl-201 uptake threshold. Results: A 65% threshold uptake using resting images was found to be the best for detecting a/dyskinetic segments that improve after myocardial revascularization from those that do not improve. Sensitivity was lower with a 65% threshold (75%) than with a 50% threshold (90%, p < 0.05), but specificity was higher (76% versus 26%, p < 0.05) resulting in better accuracy (76% versus 57%, p < 0.05) and positive predictive value (77% versus 55%), while the negative predictive value was not different (69% versus 75%, p not significant). The area under the receiver operating characteristic curve was significantly (p < 005) larger for rest (0.80 +/- 0.05) as opposed to redistribution (0.72 +/- 0.05) images. Similar results were obtained in a subgroup of patients with low ejection fraction. Significant correlations between the percentage of revascularized viable segments and both the change in ejection fraction and in postrevascularization ejection fraction were found. When these findings were applied in the validation group, a gain in specificity accuracy and positive predictive value was obtained with the 65% threshold compared with the 50% threshold. Conclusion: This study demonstrated that analysis of resting images and use of the 65% Tl-201 uptake threshold is preferable for separating viable from not viable dyssynergic myocardial segments in patients with chronic coronary artery disease.
trav.priv. Sanseverino 5/A, 80128, Napoli, Italy

trav. priv. Sanseverino 5/A, 80128, Napoli, Italy
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Liu, P., Kiess, M.C., Okada, R.D., The persistent defect on exercise thallium imaging and its fate after myocardial revascularization: Does it represent scar or ischemia (1985) Am Heart J, 110, pp. 996-1001

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Bax, J.J., Cornel, J.H., Visser, F.C., Prediction of recovery of myocardial dysfunction after revascularization. Comparison of fluorine-18 fluorodeoxyglucose/thallium-201 SPECT, thallium-201 stress-reinjection SPECT and dobutamine echocardiography (1996) J Am Coll Cardiol, 28, pp. 558-564

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Schiller, N.B., Shaha, P.M., Crawford, M., Recommendations for quantitation of the left ventricle by two-dimensional echocardiography (1989) J Am Soc Echocardiogr, 2, pp. 358-367

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Iskandrian, A.S., Hakki, A., Kane, S.A., Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting (1983) Am J Cardiol, 51, pp. 1312-1316

Udelson, J.E., Coleman, P.S., Metherall, J., Predicting recovery of severe regional dysfunction. Comparison of resting scintigraphy with thallium-201 and technetium-99m-sestamibi (1994) Circulation, 89, pp. 2552-2561

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Coversano, A., Walsh, J.F., Geltman, E.M., Perez, J.E., Bergmann, S.R., Gropler, R.J., Delineation of myocardial stunning and hibernation by positron emission tomography in advanced croronary artery disease (1996) Am Heart J, 131, pp. 440-450

Weich, H.F., Strauss, H.W., Pitt, B., The extraction of thallium-201 by the myocardium (1977) Circulation, 56, pp. 188-191

Grunwald, A.M., Watson, D.D., Holzgrefe, H.H., Irving, J.F., Beller, G.A., Myocardial thallium-201 kinetics in normal and ischemic myocardium (1981) Circulation, 64, pp. 610-618

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Gibson, R. S., Watson, D. D., Taylor, G. J., Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy (1983) J Am Coll Cardiol, 1, pp. 804-81

Melin, J. A., Wijns, W., Keyeux, A., Assessment of thallium-201 redistribution versus glucose uptake as a predictor of viability after coronary occlusion and reperfusion (1988) Circulation, 77, pp. 927-934

Sabia, P. J., Powers, E. R., Ragosta, M., Smith, W. H., Watson, D. D., Kaul, S., Role of quantitative planar thallium-201 imaging for determining viability in patients with acute myocardial infarction and a totally occluded infarct-related artery (1993) J Nucl Med, 34, pp. 728-736

Liu, P., Kiess, M. C., Okada, R. D., The persistent defect on exercise thallium imaging and its fate after myocardial revascularization: Does it represent scar or ischemia (1985) Am Heart J, 110, pp. 996-1001

Bax, J. J., Cornel, J. H., Visser, F. C., Prediction of recovery of myocardial dysfunction after revascularization. Comparison of fluorine-18 fluorodeoxyglucose/thallium-201 SPECT, thallium-201 stress-reinjection SPECT and dobutamine echocardiography (1996) J Am Coll Cardiol, 28, pp. 558-564

Vanoverschelde, J. L. J., D'Hondt, A. M., Marwivk, T., Head-to head comparison of exercise-redistribution-reinjection thallium single-photon emission computed tomograhy and low dose dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction (1996) J Am Coll Cardiol, 28, pp. 432-442

Schiller, N. B., Shaha, P. M., Crawford, M., Recommendations for quantitation of the left ventricle by two-dimensional echocardiography (1989) J Am Soc Echocardiogr, 2, pp. 358-367

Berger, B. C., Watson, D. D., Burwell, L. R., Redistribution of thallium at rest with stable and unstable angina and the effect of coronary artery bypass surgery (1979) Circulation, 60, pp. 1114-1125

Iskandrian, A. S., Hakki, A., Kane, S. A., Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting (1983) Am J Cardiol, 51, pp. 1312-1316

Udelson, J. E., Coleman, P. S., Metherall, J., Predicting recovery of severe regional dysfunction. Comparison of resting scintigraphy with thallium-201 and technetium-99m-sestamibi (1994) Circulation, 89, pp. 2552-2561

Matinho, N. V. S., Keogh, B. E., Costa, D. C., Lammerstma, A. A., Ell, P. J., Camici, P. G., Pathophysiology of chronic left ventricular dysfunction. New insight from the measurement of absolute myocardial blood flow and glucose utilization (1996) Circulation, 93, pp. 737-744

Weich, H. F., Strauss, H. W., Pitt, B., The extraction of thallium-201 by the myocardium (1977) Circulation, 56, pp. 188-191

Grunwald, A. M., Watson, D. D., Holzgrefe, H. H., Irving, J. F., Beller, G. A., Myocardial thallium-201 kinetics in normal and ischemic myocardium (1981) Circulation, 64, pp. 610-618

Uren, G. N. B., Melin, J. A., De Bruyne, B., Wijns, W., Baudhuin, T., Camici, P. G., Relation between blood flow and the severity of coronary artery stenosis (1994) N Engl J Med, 330, pp. 1782-1788

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Resting technetium-99m methoxyisobutylisonitrile cardiac imaging in chronic coronary artery disease: comparison with rest-redistribution thallium-201 scintigraphy (99 visite)
Eur J Nucl Med (ISSN: 0340-6997, 1619-7070, 1619-7089), 1993 Dec; 20(12): 1186-1192.
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Pace L, Cuocolo A, Maurea S, Nicolai E, Imbriaco M, Nappi A, Morisco C, Chiariello M, Trimarco B, Salvatore M
Reverse redistribution in resting thallium-201 myocardial scintigraphy in patients with coronary artery disease: Relation to coronary anatomy and ventricular function (116 visite)
J Nucl Med (ISSN: 0161-5505, 1535-5667, 1535-5667electronic), 1993 Oct; 34(10): 1688-1692.
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Maurea S, Cuocolo A, Pace L, Nicolai E, Nappi A, Imbriaco M, Morisco C, Chiariello M, Trimarco B, Salvatore M
Rest-injected thallium-201 redistribution and resting technetium-99m methoxyisobutylisonitrile uptake in coronary artery disease: relation to the severity of coronary artery stenosis (90 visite)
Eur J Nucl Med (ISSN: 0340-6997, 1619-7070, 1619-7089), 1993 Jun; 20(6): 502-510.
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33 Records (29 escludendo Abstract e Conferenze).
Impact factor totale: 88.251 (74.966 escludendo Abstract e Conferenze).
Impact factor a 5 anni totale: 125.516 (105.54 escludendo Abstract e Conferenze).







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