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European Journal of Nuclear Medicine and Molecular Imaging
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 4/2010

01.04.2010 | Original Article

Long-term prognostic value of early poststress 99mTc-tetrofosmin lung uptake during exercise (SPECT) myocardial perfusion imaging

verfasst von: Panagiotis Georgoulias, Ioannis Tsougos, Varvara Valotassiou, Chara Tzavara, Petros Xaplanteris, Nikolaos Demakopoulos

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 4/2010

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Abstract

Purpose

The aim of this study was to determine the long-term prognostic value of early poststress lung/heart ratio (LHR) of 99mTc-tetrofosmin radioactivity.

Methods

We studied 276 patients (aged 62.2±8.9 years, 168 men) with stress/rest 99mTc-tetrofosmin myocardial gated-SPECT and coronary angiography. To evaluate myocardial ischaemia, we calculated the summed stress score, summed rest score and summed difference score indices. For the eLHR calculation, an anterior image was acquired, 4–6 min after radiotracer injection at stress (eLHR was defined as mean counts per pixel in the lung region of interest divided by the mean counts per pixel in the myocardial region of interest). Cardiovascular death and nonfatal myocardial infarction were considered as hard cardiac events, and late revascularization procedures as soft cardiac events. The Cox proportional hazards model in a stepwise method was used to determine the independent predictors for hard and soft cardiac events.

Results

During the follow-up period hard cardiac events occurred in 28 patients (10.1%) and soft cardiac events in 32 patients (11.6%). Implying multiple Cox regression analysis, eLHR was found to be a significant independent predictor for both soft and hard cardiac events. The hazard ratio (for a 0.1 unit increase) was 4.41 (95% CI 1.52–12.73, p=0.006) for soft cardiac events and 4.22 (95% CI 2.07–8.62, p<0.001) for hard cardiac events. The other significant prognostic factors were use of β-blockers, the summed stress score and the use of nitrates for soft events, and exercise duration and the summed stress score for hard cardiac events.

Conclusion

Early poststress 99mTc-tetrofosmin LHR has an independent and powerful value in predicting hard and soft cardiac events.
Literatur
1.
Kurata C, Tawarahara K, Taguchi T, Sakata K, Yamazaki N, Naitoh Y. Lung thallium-201 uptake during exercise emission computed tomography. J Nucl Med 1991;32:417–23.PubMed
2.
Gill JB, Ruddy TD, Newell JB, Finkelstein DM, Strauss HW, Boucher CA. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317:1486–9.PubMed
3.
Μahmood S, Buscombe JR, Ell PJ. The use of thallium-201 lung/heart ratios. Eur J Nucl Med 1992;19:807–14.
4.
Hurwitz GA, O’Donoghue JP, Powe JE, Gravelle DR, MacDonald AC, Finnie KJC. Pulmonary thallium-201 uptake following dipyridamole-exercise combination compared with single modality stress-testing. Am J Cardiol 1992;69:320–6.CrossRefPubMed
5.
Κaul S, Finkelstein DM, Homma S, Leavitt M, Okada RD, Boucher CA. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 1998;12:25–34.
6.
Liu P, Kiess M, Okada RD, Strauss HW, Block PC, Pohost GM, et al. Increased thallium lung uptake after exercise in isolated left anterior descending coronary artery disease. Am J Cardiol 1985;55:1469–73.CrossRefPubMed
7.
Ηomma S, Kaul S, Boucher CA. Correlates of lung/heart ratio of thallium-201 in coronary artery disease. J Nucl Med 1987;28:1531–5.
8.
Hurwitz GA, Ghali SK, Husni M, Slomka PJ, Mattar AG, Reid RH, et al. Pulmonary uptake of technetium-99m-sestamibi induced by dipyridamole based stress or exercise. J Nucl Med 1998;39:339–45.PubMed
9.
Giubbini R, Campini R, Milan E, Zoccarato O, Orlandi C, Rossini P, et al. Evaluation of technetium-99m-sestamibi lung uptake: correlation with left ventricular function. J Nucl Med 1995;36:58–63.PubMed
10.
Saha M, Farrand TF, Brown KA. Lung uptake of technetium 99m sestamibi: relation to clinical, exercise, hemodynamic and left ventricular function variables. J Νucl Cardiol 1994;1:52–6.CrossRef
11.
Hurwitz GA, Fox SP, Driedger AA, Willems C, Powe JE. Pulmonary uptake of sestamibi on early post-stress images: angiographic relationships, incidence and kinetics. Nucl Med Commun 1993;14:15–22.CrossRefPubMed
12.
Choy JB, Leslie WD. Clinical correlates of Tc-99m sestamibi lung uptake. J Nucl Cardiol 2001;8:639–44.CrossRefPubMed
13.
Patel GM, Hauser TH, Parker JA, Pinto DS, Sanders GP, Aepfelbacher FC, et al. Quantitative relationship of stress Tc-99m sestamibi lung uptake with resting TI-201 lung uptake and with indices of left ventricular dysfunction and coronary artery disease. J Nucl Cardiol 2004;11:408–13.CrossRefPubMed
14.
Hurwitz GA. Increased extra-cardiac background uptake on immediate and delayed post-stress images with 99mΤc-sestamibi: determinants, independence and significance of counts in lung, abdomen and myocardium. Nucl Med Commun 2000;21:887–95.CrossRefPubMed
15.
Βacher-Stier C, Sharir T, Kavanagh PB, Lewin HC, Friedman JD, Miranda R, et al. Postexercise lung uptake of 99mTc-sestamibi determined by a new automatic technique: validation and application in detection of severe and extensive coronary artery disease and reduced left ventricular function. J Nucl Med 2000;41:1190–7.
16.
Romanens M, Gradel C, Saner H, Pfisterer M. Comparison of 99mTc-sestamibi lung/heart ratio, transient ischaemic dilation and perfusion defect size for the identification of severe and extensive coronary artery disease. Eur J Nucl Med 2001;28:907–10.CrossRefPubMed
17.
Hurwitz GA, Blais M, Powe JE, Champagne CL. Stress/injection protocols for myocardial scintigraphy with Tc-99m sestamibi and thallium-201: implications of early post-stress kinetics. Nucl Med Commun 1996;17:400–9.PubMedCrossRef
18.
Tsou SS, Sun SS, Kao A, Lin CC, Lee CC. Exercise and rest technetium-99m-tetrofosmin lung uptake: correlation with left ventricular ejection fraction in patients with coronary artery disease. Jpn Heart J 2002;43:515–22.CrossRefPubMed
19.
Tanigaki K, Kobayashi H, Momose M, Takara A, Kanaya S, Terada S, et al. Clinical utility of pulmonary 99mTc-tetrofosmin uptake measurement by the exercise myocardial scintigraphy in patients with ischemic heart disease. Kaku Igaku 1998;35:189–95.PubMed
20.
Οkajima T, Ueshima K, Nishiyama O, Ogawa M, Ohuchi M, Saitoh M, et al. Relationship between lung-to-heart uptake ratio of technetium-99m-tetrofosmin during exercise myocardial single photon emission computed tomographic imaging and the number of diseased coronary arteries in patients with effort angina pectoris without myocardial infarction. J Cardiol 2004;43:165–71.
21.
Heiba SI, Ziada G, Higazy E, Saleh M, Elgazzar AH. Assessment of 99Τcm-tetrofosmin lung uptake: a modified method to avoid the contribution from high chest wall activity. Nucl Med Commun 1998;19:859–66.PubMed
22.
Heo J, Cave V, Wasserleben V, Iskandrian A. Planar and tomographic imaging with technetium 99m-labeled tetrofosmin: correlation with thallium-201 and coronary angiography. J Nucl Cardiol 1994;1:17–24.CrossRef
23.
Georgoulias P, Demakopoulos N, Kontos A, Xaplanteris P, Thomadakis K, Mortzos G, et al. 99mTc-tetrofosmin myocardial perfusion imaging: a comparison with coronary angiography. Nuklearmedizin 1996;35:153–5.PubMed
24.
Sridhara BS, Braat S, Rigo P, Itti R, Cload P, Lahiri A. Comparison of myocardial perfusion imaging with technetium-99m tetrofosmin versus thallium-201 in coronary artery disease. Am J Cardiol 1993;72:1015–9.CrossRefPubMed
25.
Flamen P, Bossuyt A, Franken R. Technetium-99m-tetrofosmin in dipyridamole-stress myocardial SPECT imaging: intraindividual comparison with technetium-99m-sestamibi. J Nucl Med 1995;36:2009–15.PubMed
26.
Schinkel AFL, Elhendy A, Van Domburg RT, Bax JJ, Vourvouri EC, Bountioukos M, et al. Incremental value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of cardiac events. Am J Cardiol 2003;91:408–11.CrossRefPubMed
27.
Georgoulias P, Demakopoulos N, Kontos A, Xaplanteris P, Xydis K, Fezoylidis I. Early post-stress pulmonary uptake of 99mTc-tetrofosmin during exercise (SPECT) myocardial perfusion imaging: correlation with haemodynamic, perfusion and function parameters. Nucl Med Commun 2006;27:119–26.CrossRefPubMed
28.
Rehm PK, Atkins FB, Ziessman HA, Green SE, Akin EA, Fox LM, et al. Frequency of extra-cardiac activity and its effect on Tc-99m MIBI cardiac SPECT interpretation. Nucl Med Commun 1996;17:851–6.CrossRefPubMed
29.
Coster CD, Quan H, Finlayson A, Gao M, Halfon P, Humphries K, et al. Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium. BMC Health Serv Res 2006;6:77–82.CrossRefPubMed
30.
Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards. A statement for healthcare professionals from the American Heart Association Writing Group. Circulation 1995;91:580–615.PubMed
31.
Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA 1999;281:524–9.CrossRefPubMed
32.
Georgoulias P, Orfanakis A, Demakopoulos N, Xaplanteris P, Mortzos G, Vardas P, et al. Abnormal heart rate recovery immediately after treadmill testing: correlation with clinical, exercise testing, and myocardial perfusion parameters. J Nucl Cardiol 2003;10:498–505.CrossRefPubMed
33.
Rahimi K, Thomas A, Adam M, Hayerizadeh BF, Schuler G, Secknus MA. Implications of exercise test modality on modern prognostic markers in patients with known or suspected coronary artery disease: treadmill versus bicycle. Eur J Cardiovasc Prev Rehabil 2006;13:45–50.CrossRefPubMed
34.
Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med 2005;32:855–97.CrossRef
35.
Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jarrit PH, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med 2002;29:1608–16.CrossRef
36.
Cerquira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. J Nucl Med 2002;9:240–5.
37.
Kaminek M, Myslivecek M, Skvarilova M, Husak V, Koranda P, Metelkova I, et al. Increased prognostic value of combined myocardial perfusion SPECT imaging and the quantification of lung Tl-201 uptake. Clin Nucl Med 2002;27:255–60.CrossRefPubMed
38.
Kwok JM, Christian TF, Miller TD, Hodge DO, Gibbons RJ. Incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium 201 imaging in patients with ST-T abnormalities on their resting electrocardiograms. Am Heart J 2005;149:145–51.CrossRefPubMed
39.
Dakik HA, Mahmarian JJ, Kimball KT, Koutelou MG, Medrano R, Verani MS. Prognostic value of exercise 201Tl tomography in patients treated with thrombolytic therapy during acute myocardial infarction. Circulation 1996;94:2735–42.PubMed
40.
Jain D, Thompson B, Wackers FJ, Zaret BL. Relevance of increased lung thallium uptake on stress imaging in patients with unstable angina and non-Q wave myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI)-IIIB Study. J Am Coll Cardiol 1997;30:421–9.CrossRefPubMed
41.
Sarda L, Fuchs L, Lebtahi R, Faraggi M, Delahaye N, Hvass U, et al. Prognostic value of 201Tl myocardial scintigraphy after coronary artery bypass grafting. Nucl Med Commun 2001;22:189–96.CrossRefPubMed
42.
Krawczynska EG, Alazraki NP, Karatela R, Jones ME, Cooke CD, Garcia EV, et al. Prognosis in patients with left ventricular apical aneurysm diagnosed by thallium-201 or Tc-99m sestamibi SPECT images. Am J Cardiol 1997;79::406–411CrossRefPubMed
43.
Marcassa C, Galli M, Baroffio C, Eleuteri E, Campini R, Giannuzzi P. Independent and incremental prognostic value of 201Tl lung uptake at rest in patients with severe postischemic left ventricular dysfunction. Circulation 2000;102:1795–801.PubMed
44.
Wu YW, Yen RF, Lee CM, Ho YL, Chou NK, Wang SS, et al. Diagnostic and prognostic value of dobutamine thallium-201 single-photon emission computed tomography after heart transplantation. J Heart Lung Transplant 2005;24:544–550CrossRefPubMed
45.
Ho KT, Miller TD, Christian TF, Hodge DO, Gibbons RJ. Prediction of severe coronary artery disease and long-term outcome in patients undergoing vasodilator SPECT. J Nucl Cardiol 2001;8:438–44.CrossRefPubMed
46.
Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of lung sestamibi uptake in myocardial perfusion imaging of patients with known or suspected coronary artery disease. J Am Coll Cardiol 2005;45:1676–82.CrossRefPubMed
47.
Moralidis E, Spyridonidis T, Arsos G, Anagnostopoulos C. Identification of advanced coronary artery disease with exercise myocardial perfusion imaging: the clinical value of a novel approach for assessing lung thallium-201 uptake. Eur J Nucl Med Mol Imaging. 2007;34:573–83.CrossRefPubMed
Metadaten
Titel
Long-term prognostic value of early poststress 99mTc-tetrofosmin lung uptake during exercise (SPECT) myocardial perfusion imaging
verfasst von
Panagiotis Georgoulias
Ioannis Tsougos
Varvara Valotassiou
Chara Tzavara
Petros Xaplanteris
Nikolaos Demakopoulos
Publikationsdatum
01.04.2010
Verlag
Springer-Verlag
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 4/2010
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-009-1312-9

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