(Circulation. 1997;96:2892-2898.)
© 1997 American Heart Association, Inc.
Articles |
Assessment of Myocardial Viability With 99mTc-Sestamibi Tomography Before Coronary Bypass Graft Surgery
Correlation With Histopathology and Postoperative Improvement in Cardiac Function
From the Section of Cardiology (Department of Medicine), Departments of Surgery and Pathology, Baylor College of Medicine and The Methodist Hospital, Houston, Tex.
Correspondence to Mario S. Verani, MD, FACC, FACP, Professor of Medicine, Baylor College of Medicine, Director, Nuclear Cardiology, The Methodist Hospital, 6550 Fannin, SM-677, Houston, TX 77030. E-mail mverani{at}bcm.tmc.edu
Background Assessment of myocardial viability by 99mTc-sestamibi remains controversial. Accordingly, we investigated the use of sestamibi as a marker of myocardial viability, defined by histopathology, and for predicting improvement of myocardial function after coronary artery bypass graft surgery (CABG).
Methods and Results 99mTc-sestamibi perfusion
tomography and radionuclide angiography were performed within 2 days
before CABG in 21 patients with 
75% stenosis of the left
anterior descending coronary artery and resting anterior wall
dyssynergy. During CABG, transmural myocardial biopsies were obtained
from the dyssynergic anterior wall and from normal myocardial segments
to determine the extent of viable myocardium by
histopathology. Improvement of regional left ventricular
function was evaluated by radionuclide angiography at 6 to 8 weeks
after CABG. There was a good correlation (r=.85,
P<.001) between the quantified sestamibi activity and the
extent of viable myocardium determined morphometrically.
Among 21 biopsied dyssynergic myocardial segments, 11 improved their
function after CABG and 10 failed to improve. Biopsied segments with
improved postoperative function had significantly higher sestamibi
activity (81±5% versus 49±16%, P<.0001) and
significantly lower extent of interstitial fibrosis (7±4%
versus 31±21%, P=.0002) than segments that failed to
improve. A 55% threshold of 99mTc-sestamibi activity had
positive and negative predictive values of 79% and 100%,
respectively, for recovery of function after CABG in the biopsied
segments.
Conclusions Myocardial 99mTc-sestamibi activity correlates well with the extent of viable myocardium and predicts improvement in regional function after CABG. This lends support to the use of sestamibi as a myocardial viability agent.
Key Words: perfusion • scintigraphy • coronary disease • bypass • myocardial contraction
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