REDUCED PERFUSION ON NITRATE ENHANCED STUDY COMPARED TO RESTING WITH 99mTc-SESTAMIBI IMAGING FOR MYOCARDIAL VIABILITY

Asif Jielani, Mausab Riaz, Muhammad Anees

Abstract


Patients with ischemic heart disease and left ventricular dysfunction need evaluation for myocardial viability. Two cases of myocardial perfusion imaging for viability study are discussed. Viability imaging is performed with 99mTc-Sestamibi (99mTc-MIBI), acquiring images with and without nitrate enhancement. Improvement in perfusion in nitrate enhanced images is suggestive of myocardial viability. In these cases, there was paradox effect showing reduced uptake on nitrate enhanced images than on resting images. Technical factors of equal radiotracer dose in both studies, pre-imaging time and processing were considered. Since no such contributing factor was delineated, it is postulated that phenomena can occur due to differential effects of oral glyceryl triglyceryl trinitrate (GTN) on normal and diseased vessels.


Keywords: Myocardial viability, Glyceryl trinitrate,99mTc-Sestamibi, Radiotracers

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References


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Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002;39(7):1151–8.

Senior R, Kaul S, Raval U, Lahiri A. Impact of revascularization and myocardial viability determined by glyceryl trinitrate-enhanced Tc-99m mibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy. J Nucl Cardiol 2002;9(5):454–62.

Basu S, Senior R, Raval U, Lahiri A. Superiority of glyceryl trinitrate-enhanced 201Tl over conventional redistribution 201Tl imaging for prognostic evaluation after myocardial infarction and thrombolysis. Circulation 1997;96(9):2932–7.

Abrams J. Mechanisms of action of the organic glyceryl trinitrates in the treatment of myocardial ischemia. Am J Cardiol 1992;70(8):30B–42.

Brown BG, Bolson E, Petersen RB, Pierce CD, Dodge HT. The mechanisms of nitroglycerin action: stenosis vasodilatation as a major component of the drug response. Circulation 1981;64(6):1089–97.

Rizzello V, Poldermans D, Bax JJ. Assessment of myocardial viability in chronic ischemic heart disease: current status. Q J Nucl Med Mol Imaging 2005;49(1):81–96.

Ragosta M, Beller GA. The noninvasive assessment of myocardial viability. Clin Cardiol 1993;16(7):531–8.

Bøttcher M, Madsen MM, Randsbaek F, Refsgaard J, Dørup I, Sørensen K, et al. Effect of oral nitroglycerin and cold stress on myocardial perfusion in areas subtended by stenosed and nonstenosed coronary arteries. Am J Cardiol 2002;8(9):1019–24.

Niyaz K, Niaz K, Zaman MU, Kamal S, Usmani S, Habib S, et al. Assessment of viable myocardium by glyceryl trinitrate augmented 99mTc MIBI myocardial perfusion imaging. J Pak Med Assoc 2007;57:83–7.


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