Circulation, Vol 88, 2224-2234, Copyright © 1993 by American Heart Association
AJ Sinusas, Q Shi, PJ Vitols, RC Fetterman, P Maniawski, BL Zaret and FJ Wackers
BACKGROUND. Serial myocardial perfusion imaging with 99mTc-sestamibi (MIBI)
was used to evaluate infarct risk area and salvage after thrombolysis. The
purpose of this investigation was to determine whether changes in MIBI
defect size observed after reperfusion may result in part from distortion
of regional and global left ventricular geometry. METHODS AND RESULTS.
Twenty-five open-chest dogs were subjected to either 15 minutes (groups 1A
and 1B) or 3 hours (group 2) of left anterior descending coronary artery
occlusion followed by 3 hours of reperfusion. MIBI was injected before
occlusion (group 1A) or during occlusion (groups 1B and 2), and serial
ECG-gated planar imaging was performed. Dobutamine was infused after 3
hours of reperfusion (groups 1B and 2) to transiently alter left
ventricular size and function. Perfusion defect magnitude (DM) and extent
(DE) were serially quantified with circumferential profile analysis of
end-systolic (ES), end-diastolic (ED), and summed images. Flow was assessed
with radiolabeled microspheres and correlated with myocardial MIBI
activity. Myocardial thickening was assessed in the risk area with
sonomicrometers. In group 1A dogs, ischemic dyskinesis produced large
artifactual quantitative MIBI defects on ES images (DM, 9.3 +/- 1.3; DE,
27.8 +/- 6.0) that were significantly smaller on ED images (DM, 4.5 +/-
0.9, P < .05; DE, 4.4 +/- 2.3, P < .05). In addition, DM and DE
correlated inversely with myocardial thickening on ES images (DM, r = -
.84; DE, r = -.78) and summed images (DM, r = -.72; DE, r = -.61) but not
ED images (DM, r = -.12; DE, r = -.15). An index of defect reduction
derived from summed images correlated well with thickening fraction in
stunned dogs (group 1B, r = .89) but poorly in infarcted dogs (group 2, r =
.41) subjected to dobutamine stress. CONCLUSIONS. 99mTc-MIBI defect size
may be affected by alteration of left ventricular geometry. Changes in
regional function may confound analysis of risk area and myocardial salvage
with serial 99mTc-MIBI imaging and may also affect defect size during
pharmacological stress with dobutamine. Dobutamine 99mTc-MIBI imaging may
be useful for distinguishing viable and nonviable myocardium.
ARTICLES
Impact of regional ventricular function, geometry, and dobutamine stress on quantitative 99mTc-sestamibi defect size
Department of Internal Medicine, Yale University, School of Medicine, New Haven, Conn. 06510.
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