MiYOKARD ENFARKTÜSÜ GEÇİRMİŞ HASTALARDA CANLI DOKUNUN ARAŞTIRILMASINDA, AKUT TRİMETAZİDİN VE NİTRAT UYGULAMASI SONRASI YAPILAN Tc-99m-TETROFOSMİN GATED SPECT’İN TANI DEĞERİ

Year 2017, Volume: 2 Issue: 2, 1 - 24, 23.08.2017

Özgül Turhal Ahmet Tutuş Mustafa Kula

Abstract

ÖZET

Amaç: Miyokard
enfarktüsü geçiren hastalarda, canlı miyokard dokusunun araştırılması amacıyla
nitrat infüzyonu ve akut Trimetazidin (TMZ) sonrası Tc-99m-tetrofosmin gated
SPECT sonuçlarının karşılaştırılmasıdır.

Metod:
Çalışmaya revaskülarizasyon işlemi planlanan, MI geçirmiş 30 hasta alındı.
Hastalara ayrı günlerde bazal, nitrat infuzyonu ve akut TMZ sonrası
Tc-99m-tetrofosmin gated SPECT yapıldı. Perfuzyon görüntülerinden elde edilen
veriler kantitatif olarak, hareket görüntüleri ise görsel olarak skorlandı.
Maksimum aktivitenin % 55’inden fazlasını tutan segmentler ile normal hareket
eden veya hipokinetik olan segmentler canlı olarak yorumlandı. Elde edilen
veriler “paired samples” ve “chi-square” testleri ile değerlendirildi.

Bulgular: Bazal çalışmada cansız olarak değerlendirilen 206 segmentin 41 ’i (%
19.9), nitrat sonrası canlı olarak değerlendiriürken, TMZ sonrası 42 segment (%
20) canlı olarak değerlendirildi. Nitrat sonrası 117 segmentin (% 30)
hareketleri düzelirken, TMZ sonrası 43 segmentin (% 10) hareketlerinde düzelme
izlendi. Nitrat sonrası hesaplanan sol ventrikül EF’larında bazal çalışmaya
göre anlamlı (% 36.5±11.3, % 42.1±12.7, p<0.05) bir artış izlenirken, TMZ
sonrası anlamlı bir değişiklik izlenmedi (% 36.5±11.3, % 38.3±10.9, p>0.05).
Ayrıca, nitrat infuzyonu sonrası hastaların kan basınçlarında düşme izlenirken,
akut TMZ sonrası hastaların hemodinamik parametrelerinde anlamlı değişiklik
gözlenmedi. TMZ ve nitrat çalışmalarının perfuzyon görüntülerinin, canlılığı
belirlemedeki uyumu % 87 olarak hesaplandı.

Sonuç: Hiberne
miyokardın tespitinde; hem hareketleri düzelen segment sayısının, hem de tüm
segmentlerin ortalama aktivite tutulum oranlarının, TMZ çalışmasına göre daha
fazla olması nedeniyle, nitrat infuzyonu daha iyi olarak bulunmuştur. Ancak,
akut TMZ sonrası Tc-99m-tetrofosmin görüntülemenin, özellikle hemodinamik
paramatreleri kötü olan hastalarda kullanılabileceği sonucuna varılmıştır.

 

Keywords

Miyokard sintigrafisi, canlı doku, trimetazidin

DIAGNOSTIC VALUE of Tc-99m TETROFOSMİN GATED SPECT IN MYOCARDIAL VIABILITY INVESTIGATION AFTER ADMINISTRATION TRIMETAZIDINE and NITRATE IN THE PATIENTS WITH MYOCARDIAL INFARCTION

Abstract

ABSTRACT

 

Aim: With the aim of investigating of the myocardial viability on the patients with MI, the results obtained from Tc-99m-tetrofosmin gated SPECT following the nitrate infusion and acute TMZ were compared.

Method: For this study, 30 patients who had MI and were be planned of revascularization process were taken. The patients were applied Tc-99m-tetrofosmin gated SPECT basally and following nitrate infusion and acute TMZ separately each day. The data from perfusion were quantitatively evaluated whilst wall motion images were visually scored. The segments having more than 55% of maximum activity and moving normally or being hypo-kinetic were concluded as viable. The data obtained were statistically evaluated by “t” and “chi-square” tests.

Results: While the 41 segments (19.9%) of non-viable 206 segments from the basal study were considered as viable after nitrate study, 42 segments (20%) were considered as viable after TMZ study. While the wall motions of 117 segments improved in the nitrate study, wall-motions of 43 segments improved in the TMZ study. Although there were more significant increases (36.5% ± 11.3, 42.1% + 12.7, p<0.05) in the post-nitrate left ventricule EFs than basal study, no significant changes (36.5% ± 11.3, 38.3% ± 10.9, p>0.05) occurred in the TMZ study. Moreover, while the blood pressures of the patients decreased after nitrate, the hemodynamic parameters of patients did not change significantly after acute TMZ.

Conclusion: The concordance of perfusion images from TMZ and nitrate studies in determining the myocardial viability was calculated as 87%. In the evaluation of HM, nitrate infusion was found better since both the number of segments whose wall-motions improved and the mean activity uptake ratios of all segments were many more than the results of TMZ studies. However, it was concluded that post-TMZ Tc-99m-tetrofosmin imaging can be especially useful for the patients whose hemodynamic parameters are not well. 

Keywords

Myocardial scintigraphy, viability, trimetazidine

References

• KAYNAKLAR 1. Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 2000; 10:1465. 2. Dilsizian V, Bonow RO. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation 1993;87:1-20. 3. Tamaki N, Kawamato M, Tamadura E, et al. Prediction of reversible ischemia after revascularization: Perfusion and metabolic studies with positron emission tomography. Circulation 1995;91:1694-1705. 4. Bergman SR. Use and limitations of metabolic tracers labeled with positron- emitting radionuclides in identification of viable myocardium. J Nucl Med 1994;35(Suppl): 15S-22S. 5. Rozanski A, Berman DS, Gray R, et al. Use of thallium-201 redistribution scintigraphy in the preoperative differentiation of reversible and nonreversible myocardial asynergy. Circulation 1981;64:936-944. 6. Dilsizian V, Arrighi JA, Diodati JG, et al. Myocardial viability in patients with chronic coronary artery disease. Comparison of Tc-99m sestamibi with thallium reinjection and (F-18) fluorodeoxyglucose. Ciculation 1994;89:578-587. 7. He ZX, Darcourt J, Guignier A, et al. Nitrates improve detection of ischemic but viable myocardium by thallium-201 reinjection SPECT. J Nucl Med 1993;34:1472- 1477. 8. Sciagra R, Bisi G, Santoro GM, et al. Comparison of baseline-nitrate technetium- 99m sestamibi with rest-redistribution thallium-201 tomography in detecting viable hibernating myocardium and predicting postrevascularization recovery. J Am Coll Cardiol 1997;30 (2):384-391. 9. Flotats A, Carrio I, Estorch M, et al. Nitrate administration to enhance the detection of myocardial viability by technetium-99m tetrofosmin single-photon emission tomography. Eur J Nucl Med 1997;24(7):767-773. 10. Bisi G, Sciagra R, Santoro GM, et al. Sublingual isosorbide dinitrate to improve Tc- 99m teboraxime perfusion defect reversibility. J Nucl Med 1994;35:1274-1278. 11. Abrarams J. Hemodynamic effect of nitroglycerin and long-acting nitrates. Am heart J 1985;110:216-224. 12. Bisi G, Sciagra R, Santoro GM, et al. Tc-99m-sestamibi imaging with nitrate infusion to detect viable hibernating myocardium and predict postrevascularization recovery. JNucl Med 1995;36:1994-2000. 13. Stollfuss JC, Haas F, Matsunari I, et al. Tc-99m tetrofosmin SPECT for prediction of functional recovery defined by MRI in patients with severe left ventricular dysfunction: Additional value of gated SPECT. J Nucl Med 1999;40:1824-1831. 14. Mochizuki T, Murase K, Tanaka H, et al. Assessment of left ventricular volume using ECG-gated SPECT with Tc-99m-MIBI and Tc-99m-tetrofosmin. J Nucl Med 1997;38:53-57. 15. Ciavolella M, Greco C, Tavolaro R, et al. Acute oral trimetazidine administration increases resting Tc-99m sestamibi uptake in hibernating myocardium. J Nucl Cardiol 1998;5:128-133. 16. Spadafora M, Cuocolo A, Golia R, et al. Effect of trimetazidine on Tc-99m- tetrofosmin uptake in patients with coronary artery disease. Nucl Med Com 2000;21:49-54. 17. Gunning MG, Anagnostopoulos C, Davies G, et al. Simultaneous assessment of myocardial viability and function for the detection of hibernating myocardium using ECG-gated Tc-99m-tetrofosmin emission tomography: A comprasion with Tl-201 emission tomography combined with cine magnetic resonance imaging. Nucl Med Comm 1999;20:209-214. 18. Matsunari I, Fujino S, Taki J, et al. Myocardial viability assessment with Technetium-99m-tetrofosmin and Thallium-201 reinjection in coronary artery disease. J Nucl Med 1995;36:1961-1967. 19. Beanlands RSB, Dawood F, Wen WH, et al. Are the kinetics of technetium-99m methoxyisobutyl isonitrile affected by cell metabolism and viability? Circulation 1990;82:1802-1814. 20. Glover DK, Ruiz M, Allen TR, et al. Myocardial uptake of Tc-99m tetrosomin in canine models of coronary occlusion and reperfusion. Circulation 1993;88:441-453. 21. Kelly JD, Forster AM, Higley B, et al. Tc-99m Tetrofosmin as a new radiopharmaceutical for myocardial imaging. J Nucl Med 1993;34:222-227. 22. 0pie LH, Hesse B. Radionuclide tracers in the evaluation of resting myocardial ischaemia and viability. Eur J Nucl Med 1997;24:1183-1193. 23. Nicolai E, Cuocolo A, Acampa W, et al. Exercise-rest Tc-99m tetrofosmin SPECT in patients with chronic ischemic left ventricular dysfunction: direct comparison with Tl-201 reinjection. JNucl Cardiol 1999;6:270-277. 24. Bolli R, Marban E. Molecular and cellular mechanism of myocardial stunning. Physiological Reviews 1999;79:609-634. 25. Kloner RA, Bolli R, Marban E, et al. Medical and cellular implications of stunning, hibernation and preconditioning. Circulation 1998;97:1848-1867. 26. Heusch G. Hibernating myocardium. Physiological Reviews 1999;78:1055-1085. 27. Brown BG, Bolson R, Petersen RB, et al. The mechanism of nitroglycerin action: Stenosis vasodilatation as a major component of drug response. Circulation 1981;64:1089-1097. 28. Demasion L, Fantini E, Sentex E, et al. Trimetazidine: in vitro influence on heart mitochondrial function. AmJ Cardiol 1995;76:31-37. 29. Guamieri C, Muscari C. Benefical effects of trimetazidine on mitochondrial function and superoxide production in cardiac muscle of monocrotaline-treated rats. Biochem Pharmacol 1988;24:4685-4693. 30. Renaud JF. internal pH, Na(+) and Ca(++) regulation by trimetazidine during cardiac cell acidosis. Cardiovasc Drugs Ther 1988;1:677-686. 31. Demasion L, Fantini E, Sentex E, et al. Trimetazidine: in vitro influence on heart mitochondrial function. AmJ Cardiol 1995;76:31-37. 32. Matsunari I, Boning G, Ziegler SI, et al. Attenuation-corrected 99mTc-tetrofosmin SPECT in detection of viable myocardium: comparison with PET using 18F- fluorodeoxyglucose. J AmColl Cardiol 1998;32:927-962. 33. Flotats A, Carrio I, Estorch M, et al. Evaluation of myocarial viability using perfusion cardiac SPECT. Tl-201 rest/redistribution, Tl-201 rest/reinjection and Tc- 99m tetrofosmin rest/postnitrate. Rev Esp Cardiol 1998;51:45-52. 34. Flotats A, Carrio I, Estorch M, et al. Nitrate administration to enhance the detection of myocardial viability by technetium-99m tetrofosmin SPECT. Eur J Nucl Med 1997;24:767-773. 35. Duncan BH, Ahlberg AW, Levine Mg, et al. Comparison of electrocardiographic-gated technetium-99m sestamibi SPECT imaging and rest- redistribution thallium-201 in the prediction of myocardial viability. Am J Cardiol 2000;85:680-684. 36. Wahba FF, Bavelaar-Croon CD, Baur LH, et al. Detection of residual wall motion after sustained myocardial infarction by gated Tc-99m-tetrofosmin SPECT: a comparison with echocardiography. Nucl Med Comm 2001 ;22(2): 175-182.