니트로글리세린 부하 Tc-99m MIBI 정량게이트 심근 SPECT를 이용한 관동맥우회로술 후 심근수축기능 회복 예측 (Nitroglycerin-Challenged Tc-99m MIBI Quantitative Gated SPECT to Predict Functional Recovery After Coronary Artery Bypass Surgery) |
Author |
이동수,김유경,천기정,팽진철,이명묵,김기봉,정준기,이명철, |
Dong Soo Lee, M.D., Yu Kyeong Kim, M.D., Gi Jeong Cheon, M.D., Jin Chul Paeng, M.D.,Myoung Mook Lee, M.D.,©ö Ki-Bong Kim, M.D.,©÷ June-Key Chung M.D.,Myung Chul Lee, M.D. |
Affiliation |
서울대학교 의과대학 핵의학교실, 내과학교실, 흉부외과학교실 Departments of Nuclear Medicine, Internal Medicine and Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea |
Abstract |
The performance of nitroglycerin-challenged Tc-99m-MIBI quantitative gated SPECT for the
detection of viable myocardium was compared with rest/ 24-hour redistribution Tl-201 SPECT. Materials
and Methods: In 22 patients with coronary artery disease, rest Tl-201/ dipyridamole stress Tc-99m-MIBI
gated/ 24-hour redistribution Tl-201 SPECT were performed, and gated SPECT was repeated on-site after
sublingual administration of nitroglycerin (0.6 mg). Follow-up gated SPECT was done 3 months after
coronary artery bypass graft surgery. For 20 segments per patient, perfusion at rest and 24-hour
redistribution, and wall motion and thickening at baseline and nitroglycerin-challenged state were quantified.
Quantitative viability markers were evaluated and compared;(1) rest thallium uptake, (2) thallium uptake on
24-hour redistribution SPECT, (3) systolic wall thickening at baseline, and (4) systolic wall thickening with
nitroglycerin-challenge. Results: Among 100 revascularized dysfunctional segments, wall motion improved
in 66 segments (66%) on follow-up gated myocardial SPECT after bypass surgery. On receiver operating
characteristic (ROC) curve analysis, the sensitivity and specificity of rest and 24-hour delayed redistribution
Tl-201 SPECT were 79%, 44% and 82%, 44%, respectively, at the optimal cutoff value of 50% of Tl-201
uptake. The sensitivity and specificity of systolic wall thickening at baseline and nitroglycerin-challenge were
49%, 50% and 64%, 65% at the optimal cutoff value of 15% of systolic wall thickening. Area under the ROC
curve of nitroglycerin-challenged systolic wall thickening was significantly larger than that of baseline systolic
wall thickening (p=0.004). Conclusion: Nitroglycerin-challenged quantitative gated Tc-99m-MIBI SPECT
was a useful method for predicting functional recovery of dysfunctional myocardium. |
Keyword |
Quantitative gated myocardial SPECT, nitroglycerin, rest-redistribution Tl-201 SPECT |
Full text Article |
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