High-Dose Dipyridamole and Gated Sestamibi SPECT Imaging Provide Diagnostic Resting and Stress Ejection Fractions Useful for Predicting Extent of Coronary Artery Disease

Abstract

A decline in ejection fraction at stress compared with rest images has been associated with increased severity of coronary artery disease (CAD) and suggests a poorer prognosis. Myocardial perfusion imaging (MPI) using high-dose dipyridamole (HDD) has been shown to more accurately detect CAD than either standard dose dipyridamole (SDD) or exercise-induced stress (EST), but has not been looked at to determine its usefulness in detecting changes in stress and rest ejection fractions. To determine the relationship between changes in left ventricular ejection fraction (LVEF) and the severity of CAD, 36 individuals underwent gated single photon emission computed tomography (SPECT) MPI using HDD. In each case resting and stress LVEFs were determined along with MPI results. Subjects with single-vessel CAD demonstrated an increase in LVEF from 77.8% (sd ±8.8%) to 85.6% (sd ±8.4%) resulting in a statistically significant increase in LVEF of 7.8% (p = 0.009). Patients with two-vessel disease showed a smaller increase from 73.2% (sd + 8.3%) to 79.8% (sd + 9.8%) following HDD stress. This increase was statistically (p=0.008) significant. Patients with triple-vessel CAD showed a reduction in LVEF from 67.4% (sd ± 14.07) to 65.1 % (sd ± 16.5%) which represented a decrease in LVEF of 2.7% and approached (p=0.25) but did not reach statistical significance. Both the resting and stress LVEFs were statistically lower (p<0.05) in patients with triple- vessel CAD. Changes in resting LVEF (REF) and HDD pharmacologically induced stress LVEF (SEF) provide a valuable diagnostic marker as to the number of significantly diseased coronary arteries and can be acquired from gated SPECT sestamibi images.

Get full access to this article

View all access options for this article.

References

Berger HJ , Reduto LA , Johnstone DE , et al: Global and regional left ventricular response to bicycle exercise in coronary artery disease. Assessment by quantitative radionuclide angiocardiography. Am J Med 66:13-21, 1979.

Borer JS , Kent KM , Bacharach SL , et al: Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease. Comparison with exercise electrocardiography. Circulation 60:572-580, 1979.

Port S. , Cobb FR , Coleman E. , et al: Effect of age on the response of the left ventricular ejection fraction to exercise. N Engl J Med 303:1133-1137, 1980.

Jones RH , Floyd RD , Austin EH , et al: The role of radionuclide angiocardiography in the preoperative prediction of pain relief and prolonged survival following coronary artery bypass grafting. Ann Surg 197:743-754, 1982.

Pryor DB , Harrell FE Jr, Lee KL , et al: Prognostic indicators from radionuclide angiography in medically treated patients with coronary artery disease. Am J Cardiol 53:18-22, 1984.

Lee KL , Pryor DB , Pieper KS , et al: Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease: A comparison with clinical and catheterization variables. Circulation 82:1705-1717, 1990 .

Hambye AS , Dobbeleir A. , Vervaet A. , et al: Can we rely on 99Tcm-sestamibi gated tomographic myocardial perfusion imaging to quantify left ventricular function? A comparative study with classical isotopic techniques for the measurement of ejection fraction . Nucl Med Commun 18:751-760, 1997.

Yang KT , Chen HD : Evaluation of global and regional left ventricular function using technetium-99m sestamibi EKG-gated single-photon emission tomography. Eur J Nucl Med 25:515-521, 1998.

Manrique A. , Faraggi M. , Vera P. , et al: 201T1 and 99mTc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: Comparison with equilibrium radionuclide angiography. J Nucl Med 40:810-813, 1999.

10.

Maurea S. , Cuocolo A. , Pace L. , et al: Left ventricular dysfunction in coronary artery disease: Comparison between rest-redistribution thallium 201 and resting technetium 99m methoxyisobutyl isonitrile cardiac imaging. J Nucl Cardiol 1:65-71, 1994.

11.

DePuey EG , Parmett S. , Ghesani M. , et al: Comparison of Tc-99m sestamibi and Tl-201 gated perfusion SPECT . J Nucl Cardiol 6:278-285, 1999.

12.

Friedman JD , Berman DS , Kiat H. , et al: Rest and treadmill exercise first-pass radionuclide ventriculography : Validation of left ventricular ejection fraction measurements. J Nucl Cardiol 1:382-388, 1994.

13.

Benari B. , Kiat H. , Erel J. , et al: Repeatability of treadmill exercise ejection fraction and wall motion using technetium 99m-labeled sestamibi first-pass radionuclide ventriculography . J Nucl Cardiol 2 :478-484, 1995.

14.

Schmoliner R. , Dudczak R. , Kronik G. , et al: Thallium-201-myocardial imaging after high dose dipyridamole. Z Kardiol 70:111-115, 1981.

15.

Gould KL , Sorenson SG , Albro P. , et al: Thallium-201 myocardial imaging during coronary vasodilation induced by oral dipyridamole. J Nucl Med 27:31-36, 1986.

16.

Masini M. , Picano E. , Lattanzi F. , et al: High-dose dipyridamole-echocardiography test in women: Correlation with exercise-electrocardiography test and coronary arteriography. J Am Coll Cardiol 12:682-685, 1988.

17.

Bolognese L. , Sarrasso G. , Aralda D. , et al: High-dose dipyridamole echocardiography early after uncomplicated acute myocardial infarction: correlation with exercise testing and coronary angiography. J Am Coll Cardiol 14:357-363, 1989.

18.

Pirelli S. , Danzi GB , Alberti A. , et al: Comparison of usefulness of high-dose dipyridamole echocardiography and exercise electrocardiography for detection of asymptomatic restenosis after coronary angioplasty. Am J Cardiol 67:1335-1338, 1991.

19.

Casolo C. , Bonechi F. , Taddei T. , et al: Changes in the wall motion of left ventricle in dipyridamole-induced ischemic cardiopathy studied by nuclear magnetic resonance. A comparison with myocardial scintigraphy with 99mTc MIBI. G Ital Cardiol 21:609-617, 1991.

20.

Kettunen R. , Huikuri HV , Heikkila J. , et al: Usefulness of technetium-99m-MIBI and thallium-201 in tomographic imaging combined with high-dose dipyridamole and handgrip exercise for detecting coronary artery disease. Am J Cardiol 68:575-579, 1991.

21.

Kettunen R. , Huikuri HV , Heikkila J. , et al: Preoperative diagnosis of coronary artery disease in patients with valvular heart disease using technetium-99m isonitrile tomographic imaging together with high-dose dipyridamole and handgrip exercise. Am J Cardiol 69:1442-1445, 1992 .

22.

Lalonde D. , Taillefer R. , Lambert R. , et al: Thallium-201-dipyridamole imaging: Comparison between a standard dose and a high dose of dipyridamole in the detection of coronary artery disease . J Nucl Med 35:1245-1253, 1994 .

23.

Cramer MJ , Verzijlbergen JF , van der Wall EE , et al: Comparison of adenosine and high-dose dipyridamole both combined with low-level exercise stress for 99Tcm-MIBI SPECT myocardial perfusion imaging . Nucl Med Commun 17:97-104, 1996.

24.

Yoshida K. , Mullani N. , Gould KL : Coronary flow and flow reserve by PET simplified for clinical applications using rubidium-82 or nitrogen-13-ammonia. J Nucl Med 37:1701-1712, 1996.

25.

Maffei S. , Baroni M. , Terrazzi M. , et al: Preoperative assessment of coronary artery disease in aortic stenosis : A dipyridamole echocardiographic study. Ann Thorac Surg 65:397-402, 1998.

26.

Fleming RM , Rose CH , Feldmann KM : Comparing a high-dose dipyridamole SPECT imaging protocol with dobutamine and exercise stress testing protocols. Angiology 46:547-556, 1995.

27.

Fleming RM , Feldmann KM , Fleming DM : Comparing a high-dose dipyridamole SPECT imaging protocol with dobutamine and exercise stress testing protocols. Part II. Using high-dose dipyridamole to determine lung-to-heart ratios. Int J Angiol 7:325-328, 1998.

28.

Fleming RM , Feldmann KM , Fleming DM : Comparing a high-dose dipyridamole SPECT imaging protocol with dobutamine and exercise stress testing protocols. Part III. Using dobutamine to determine lung-to-heart ratios, left ventricular dysfunction, and a potential viability marker. Int J Angiol 8:325-328, 1999.

29.

Fleming RM : Chapter 31: Nuclear Cardiology: Its Role in the Detection and Management of Coronary Artery Disease. In: Textbook of Angiology, ed. by Chang JC. New York: Springer-Verlag, 1999, pp 397-406.

30.

Fleming RM , Kirkeeide RL , Taegtmeyer H. , et al: Comparison of technetium-99m teboroxime tomography with automated quantitative coronary arteriography and thallium-201 tomographic imaging. J Am Coll Cardiol 17:1297-1302, 1991 .