CLINICAL USEFULNESS OF Tc-99m HEXAKIS 2-METHOXYISOBUTYL ISONITRILE GATED SPECT IN PATIENTS WITH DILATED CARDIOMYOPATHY: RETROSPECTIVE ANALYSIS

Zahid Rahman Khan, Nat E. Watson, Afshan Zahid Khan

Abstract


Background: In Dilated cardiomyopathy the heart is enlarged and ventricles are dilated. Gated
myocardial perfusion single photon emission computed tomography is considered state of the art for
myocardial perfusion imaging. A retrospective analysis was conducted to evaluate patients with dilated
cardiomyopathy with Tc-99m sestamibi gated myocardial perfusion single photon emission computed
tomography to evaluate its clinical utility. Methods: A 10 year retrospective medical record review was
done from 1991 to 2001 at Wake Forest University, North Carolina, USA. Eligibility criteria included a
diagnosis of dilated cardiomyopathy and availability of coronary angiography and Tc-99m sestamibi
cardiac imaging results. 26 cases were selected for the final review and inclusion in the study. The
study was done with standard protocols for cardiac sestamibi imaging. Results: A total of 26 cases
were included in the final analysis. Cases were divided into two main groups. Group-A included 16
patients with no correlation between Tc-99m sestamibi and cardiac catheterisation reports. Group-B
included 10 patients with good correlation between the above tests. There were no significant
differences between the left ventricular ejection fraction, angina history, sex distribution and diabetic
status between the two groups. We applied Wilcoxon Signed Rank Test and z-test to quantify the
difference between the two groups. Data was tabulated and z-test was performed. The calculated pvalue was <0.0001. This is significantly less than the tabulated p-value at 5% level of significance, i.e.,
1.96. Significant differences exist between Group-A and Group-B. Conclusion: Tc-99m sestamibi is an
excellent agent for investigating myocardial perfusion in dilated cardiomyopathy. The reversible and
fixed perfusion defects (small to medium sized) seen in dilated cardiomyopathy after performance of
Tc-99m sestamibi gated single photon emission computed tomography imaging may not be due to
coronary artery disease. Tc-99m sestamibi single photon emission computed tomography is useful as a
routine non-invasive technique to evaluate myocardial function in dilated cardiomyopathy.
Keywords: Gated single photon emission computed tomography, dilated cardiomyopathy,
sestamibi, positron emission tomography

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