Abstract
With99mTc-MIBI SPECT and a 4 h exercise (E; 150 MBq iv) and rest (R; 800 MBq iv) protocol global and regional left ventricular (LV) myocardial uptake was determined in 70 patients with angiographicall, confirmed coronary heart disease (CHD) and in 10 controls. The aim was to establish an E/R ratio as a correlate to coronary vascular reserve, representing perfusion reserve (PR). E/R ratios, obtained from total LV myocardium or from normal or impaired regions, were > 1.19 under all conditions, indicating the presence of higher flow during exercise than at rest (even in areas of low flow). Global PR separated (P<0.01) controls (1.63±0.21; mean ± SD) from severely diseased patients (1.29 ±0.14 in 2- or 3-vessel disease) only. Improved differential diagnosis was gained from calibrating the regional E/R ratio to regional differences (E minus R) of uptake. For the left ventricle regional PRs (RPR) for 25 ROIs of the target, framing the myocardium, were determined RPR at the regional maximum of99mTc-MIBI uptake was similar in both controls (1.66) and patients (1.63), indicating a high probability of meeting some areas with functionally normal perfusion in patients with CHD. RPR allowed sufficient separation (P<0.025) concerning the degree of coronary artery stenosis (RPR in occlusion, 0.26; stenosis >75%, 0.39; <75%, 0.56). In controls, the overall value for RPR was 1.14+0.28 (P< 0.001). LV global PR and RPR were useful in separating patients with CHD vs controls and in classifying the severity of vascular stenosis.
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Buell U, Dupont F, Kaiser HJ, Kleinhans E, Uebis R, Simon HJ (1988) Exercise/rest Tc-99m HMIBI-SPECT to diagnose coronary heart disease (CHD): results of a four hours protocol using quantification. Eur J Nucl Med 14:253 (abstr)
Buell U, Dupont F, Kaiser HJ, Uebis R, Kleinhans E, Reske SN, Hanrath P (1989) Exercise/rest Tc-99m MIBI-SPECT in a 4 hours protocol using regional quantification to evaluate coronary heart disease (CHD). J Nucl Med 30:791 (abstr)
Buell U, Dupont F, Uebis R, Kaiser HJ, Kohlen S, Kleinhans E, Reske SN, Hanrath P (1990) Tc-99m methoxy-isobutyl-isonitrile (MIBI)-SPECT to evaluate a perfusion index (PI) from regional myocardial uptake after exercise and rest. Results of a 4 hours protocol in patients with coronary heart disease and in controls. Nucl Med Comm (in press)
Gould KL, Mullani N, Kirkeeide R (1986) Coronary circulation. In: Phelps ME, Mazziotta JC, Schelbert HR (eds) Positron emission tomography and autoradiography. Raven, New York, p 113
Holmberg SW, Serzysko W, Varaunakas E (1971) Coronary circulation during heavy exercise in control subjects and patients with coronary disease. Acta Med Scand 190:465–480
Klocke FJ (1987) Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 76:1183–1189
Li QS, Frank TL, Franceschi D, Wagner HN, Becker LC (1988) Technetium-99m methoxyisobutyl isonitrile (RP 30) for quantification of myocardial ischemia and reperfusion in dogs. J Nucl Med 29:1539–1548
Melin JA, De Coster PM, Renkin J, Detry JMR, Beckers C, Col J (1985) Effect of intracoronary thrombolytic therapy on exercise-induced ischemia after acute myocardial infarction. Am J Cardiol 56:705–711
Okada RD, Glover D, Gaffney T, Williams St (1988) Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile. Circulation 77:491–498
Parker JO, West RO, Di Giorgi S (1971) The effect of nitroglycerine on coronary blood flow and the hemodynamic response to exercise in coronary artery disease. Am J Cardiol 27:59–65
Selwyn AP, Allan RM, L'Abbate A, Horlock P, Camici P, Clark J, O'Brien HA, Grant PM (1982) Relation between regional myocardial uptake of rubidium-82 and perfusion: absolute reduction of cation uptake in ischemia. Am J Cardiol 50:112–119
Stirner H, Buell U, Kleinhans E (1986) Three-dimensional ROIbased quantification of stress/rest 201 TI myocardial SPELT: presentation of method. Nucl Med 25:128–133
Stirner H, Buell U, Kleinhans E, Bares R, Grosse W (1988) Myocardial kinetics of 99mTc hexakis-(2-methoxy-isobutyl-isonitrile) (HMIBI) patients with coronary heart disease: a comparative study versus 201-T1 with SPELT. Nucl Med Comm 9:1523
Strauer BE (1982) Die Sondierung des Herzens (einschl. Messgrössen). In: Riecker G (ed) Klinische Kardiologie. Springer, Berlin Heidelberg New York, p 72
Strauer BE, Buell U, Buerger S (1978) Clinical and experimental analysis of 201-thallium uptake of the heart. Nucl Med 17:142–148
Taillefer R, Gagnon A, Laflamme L, Gregoire J, Leveille J, Phaneuf DC (1989) Same day injections of Tc-99 methoxy isobutyl isonitrile (hexamibi) for myocardial tomographic imaging: comparison between rest-stress and stress-rest injection sequences. Eur J Nucl Med 15:113–117
Wackers FIT, Berman DS, Maddahi J, Watson DD, Beller GA, Strauss HW, Boucher ChA, Picard M, Holman BL, Fridrich R (1989) Technetium-99m hexakis 2-methoxyisobutyl isonitrile: human biodistribution, dosimetry and safety, and preliminary comparison to thallium-201 for myocardial perfusion imaging. J Nucl Med 30:301–311
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Dedicated to Prof. Dr. D. Emrich, Göttingen on the occasion of his 60th birthday
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Buell, U., Kaiser, HJ., Dupont, F. et al. Methoxyisobutylisonitrile (MIBI) Tc 99m SPECT to establish a correlate to coronary flow reserve, the perfusion reserve, from global and regional myocardial uptake after exercise and rest. Eur J Nucl Med 16, 3–9 (1990). https://doi.org/10.1007/BF01566004
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DOI: https://doi.org/10.1007/BF01566004