Myocardial ischaemia detection: 99mTc-sestamibi versus echocardiography during dobutamine stress

Chronic ischaemic heart disease (IHD) is one of the most common cardiac conditions worldwide and is generally caused by the consequences of coronary atherosclerosis, including myocardial infarction. Clinical challenges in chronic IHD include detection of myocardial ischaemia in symptomatic patients with suspected coronary artery disease (CAD), evaluation of myocardial viability in patients with established IHD and poor left ventricular ejection fraction (LVEF) when revascularization is considered, as well as risk stratification and identification of patients with chronic IHD at high risk of complications. Cardiovascular magnetic resonance (CMR) can provide vital answers to all three of these challenges. Stress CMR is now increasingly used to detect ischaemia by means of vasodilator stress perfusion or dobutamine stress contractile reserve stress imaging. For viability assessment, late gadolinium enhancement is currently the method of choice to detect myocardial infarction, and low-dose dobutamine stress magnetic resonance can provide additional information to determine viability and guide therapy. Cardiovascular risk in patients with chronic IHD is mainly determined by left ventricular function, most commonly utilizing LVEF, as well as infarct size, infarct characteristics, and ischaemic burden, which can all be measured reliably with CMR. This chapter will review the role of CMR for the detection of myocardial ischaemia, viability, and risk.

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Increased 99mTc-Sestamibi Washout Reflects Impaired Myocardial Contractile and Relaxation Reserve During Dobutamine Stress Due to Mitochondrial Dysfunction in Dilated Cardiomyopathy Patients

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.01.074 ◽

2013 ◽

Vol 61 (19) ◽

pp. 2007-2017 ◽

Cited By ~ 29

Author(s):

Daisuke Hayashi ◽

Satoru Ohshima ◽

Satoshi Isobe ◽

Xian Wu Cheng ◽

Kazumasa Unno ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Mitochondrial Dysfunction ◽

Dobutamine Stress ◽

Myocardial Contractile ◽

99Mtc Sestamibi

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Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.254 ◽

2019 ◽

Vol 7 (8) ◽

pp. 1287-1292

Author(s):

Bhupendra Verma ◽

Amrita Singh

Keyword(s):

Myocardial Viability ◽

Stress Echocardiography ◽

Low Dose ◽

Dobutamine Stress Echocardiography ◽

Dobutamine Stress ◽

Left Ventricular ◽

Contrast Enhanced ◽

Myocardial Perfusion Scan ◽

Perfusion Scan ◽

99Mtc Sestamibi

INTRODUCTION: Dobutamine stress echocardiography (DSE) and myocardial perfusion scan are the commonly used modalities to detect viable myocardium. DSE is comparatively cheaper and widely available but has a lower sensitivity. AIM: We aimed to compare contrast-enhanced low-dose dobutamine echocardiography (LDDE) and gated 99mTc-sestamibi myocardial perfusion scan (MPS) for the degree of agreement in the detection of myocardial viability. METHODS: We studied 850 left ventricular segments from 50 patients (42 men, mean age 55.5 years), with coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 40%), using contrast-enhanced LDDE and 99mTc-Sestamibi gated SPECT. Segments were assessed for the presence of viability by both techniques and head to head comparisons were made. RESULTS: Adequate visualisation increased from 80% in unenhanced segments to 96% in contrast-enhanced segments. Of the total 850 segments studied, 290 segments (34.1%) had abnormal contraction (dysfunctional). Among these, 138 were hypokinetic (16.2% of total), 144 were severely hypokinetic or akinetic (16.9% of total), and 8 segments were dyskinetic or aneurismal (0.9% of total). Among 151 segments considered viable by technetium, 137 (90.7%) showed contractile improvement with dobutamine; in contrast, only 8 of the 139 segments (5.7%) considered nonviable by technetium had a positive dobutamine response. The per cent of agreement between technetium uptake and a positive response to dobutamine was 78.6% with kappa = 0.63, suggestive of a substantial degree of agreement between the two modalities. CONCLUSION: Use of contrast-enhanced LDDE significantly increased the adequate endocardial border visualisation. Furthermore, this study showed a strong degree of agreement between the modalities in the detection of viable segments. So, contrast-enhanced LDDE appears to be a safe and comparable alternative to MPS in myocardial viability assessment.

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