PREOPERATIVE IDENTIFICATION OF VIABLE MYOCARDIUM - EFFECTIVENESS OF NITROGLYCERINE-INDUCED CHANGES IN MYOCARDIAL SESTAMIBI UPTAKE

In order to predict tissue viability in infarcted myocardial areas, ch anges induced by nitroglycerine infusion on Sestamibi myocardial uptak e were evaluated in 37 patients with previously confirmed myocardial i nfarction undergoing coronary artery bypass grafting, and compared wit h echocardiographic and perfusional changes occurring after the operat ion. The improvement of Sestamibi uptake after nitroglycerine correctl y classified 24/26 (92%) patients showing postoperative improvement of wall motion in the infarcted area, whereas 24/31 (77%) patients with nitroglycerine-induced increase in Sestamibi uptake had improved wall motion after operation. The presence of collateral flow to the infarct ed area was associated with a significantly (P < 0.01) higher increase in Sestamibi uptake both during nitroglycerine infusion and postopera tively, An increase in wall motion score after operation was associate d with a significantly higher (P < 0.05) increase in Sestamibi uptake score during nitroglycerine infusion. Thus, the results of this study suggest that Sestamibi perfusional myocardial scintigraphy during nitr oglycerine infusion is capable of assessing viable but chronically hyp operfused myocardium and predicting postoperative wall motion and perf usional improvement. to yield the best results in patients with eviden ce of collateral circulation that supplies the infarcted area. (C) 199 8 The International Society of Cardiovascular Surgery. Published by El sevier Science Ltd. All rights reserved.