Sestamibi SPECT in the detection of myocardial viability in patients with chronic ischemic left ventricular dysfunction: Comparison between visual and quantitative analysis

Background. Technetium 99m sestamibi cardiac scintigraphy is widely used as a means of predicting myocardial viability in patients with chronic ischem ic left ventricular (LV) dysfunction, No data are available comparing the r esults of visual and quantitative analysis of tomographic imaging in the as sessment of myocardial viability, The aim of this study was to directly com pare visual and quantitative analysis of resting sestamibi single photon em ission computed tomography in the identification of viable myocardium in pa tients with chronic LV dysfunction. Methods and Results. Sixty-five patients with an earlier myocardial infarct ion and LV dysfunction that had occurred within 1 week underwent echocardio graphy and resting sestamibi SPECT. In each patient, regional tracer distri bution was visually assessed and quantitatively measured in 13 segments. Re gional LV function was evaluated in corresponding segments by means of echo cardiography, All patients underwent revascularization, and echocardiograph y was repeated 12 months later as a means of assessing the recovery of regi onal LV function, Among all akinetic or dyskinetic revascularized segments, 66 of 112 viable segments (59%) and 85 of 100 nonviable segments (81%) wer e identified by means of visual analysis. Eighty-two of 112 viable segments (73%; P < .05 vs visual analysis) and 74 of 100 nonviable segments (74%; P = .3 vs visual analysis) were identified by means of quantitative analysis , with a threshold of 55%, Receiver operating characteristic curve areas co nstructed by using visual and quantitative analyses for the detection of my ocardial viability in all 212 akinetic or dyskinetic segments were 0.79 +/- 0.04 and 0.81 +/- 0.03, respectively (P = not significant). Overall concor dance in the detection of myocardial viability between visual and quantitat ive analysis was observed in 165 of akinetic or dyskinetic dysfunctional se gments (78%), with a K value of 0.6. Conclusions. The results of this study demonstrate that, in patients with c hronic myocardial infarction and LV dysfunction, visual and quantitative an alysis of sestamibi tomographic images at rest have similar overall accurac y in predicting the recovery of LV function after coronary revascularizatio n procedures,.