Myocardial revascularization assessment using diastolic quantitative SESTAMIBI perfusion SPECT and 2-D echocardiography pre- and post-procedure

Thirty-six coronary artery disease patients were studied pre- and post-revascularization (angioplasty or bypass surgery) with perfusion gated 6-methoxyisobutyl isonitrile (SESTAMIBI) single photon emission computed tomography (SPECT) and 2-D echocardiography (2-D echo) to evaluate myocardial perfusion and motion recovery (32 males/4 females, mean age 57 years; 31 with myocardial infarctions, all with abnormal contrast ventriculograms). Post-revascularization 2-D echo was performed at 69 days and SPECT at 64 days post-procedure as a mean. The results were compared with a normal Chilean diastolic database. Visual analysis of perfusion images and bullseye and 2-D echo wall motion were compared, evaluating changes only in revascularized segments. Five myocardial segments and bullseye quantitative parameters were observed according to 2-D echo results: (a) reduction in total perfusion defect size; and (b) reduction in global defect severity. These were obtained from the difference between pre- and post-revascularization scans in the number of pixels and the standard deviation (SD). The results were: (1) the global segmental concordance between perfusion and wall motion was 66% (κ:0.26). Discordant segments were read as improvement only in the perfusion scan in 20% and only in wall motion in 14%. (2) Quantitative data showed that those segments with improved wall motion had a 49% reduction in perfusion defect size and 59% decrease in severity. Those without changes had reductions of 27% and 31%, respectively. The differences were significant (p: 0.01 and 0.002) for the reduction in size and severity parameters. There was no difference in ischaemia reduction. (3) Bypass surgery resulted in a greater reduction in defect severity. The conclusion is: quantitative gated perfusion data are helpful in the evaluation of coronary revascularization. (author). 40 refs, 2 tabs