Enhanced detection of reversible perfusion defects by Tc-99m sestamibi compared to Tc-99m tetrofosmin during vasodilator stress SPECT imaging in mild-to-moderate coronary artery disease

OBJECTIVES We prospectively compared dipyridamole single-photon emission co mputed tomography (SPECT) imaging with Tc-99m sestamibi and Tc-99m tetrofos min for the detection of reversible perfusion defects in patients with mild -to-moderate coronary artery disease. BACKGROUND Tc-99m tetrofosmin has a lower first-pass myocardial extraction fraction compared to Tc-99m sestamibi and thus could underestimate mild per fusion defects. METHODS Eighty-one patients with 50% to 90% stenosis in one or two major ep icardial vessels without previous myocardial infarction, and seven with <5% probability of coronary artery disease underwent dipyridamole SPECT imagin g with both agents. The SPECT data were analyzed quantitatively. RESULTS Tc-99m sestamibi detected reversible perfusion defects in a greater number of segments (total 363 and 285, p < 0.001, and mean +/- SD, 2.2 +/- 3.0 and 1.8 +/- 2.5 per patient, p = 0.008, for Tc-99m sestamibi and Tc-99 m tetrofosmin, respectively), demonstrated a lamer extent of perfusion defe ct (mean +/- SD, 15.8% +/- 12.3% and 12.0% +/- 11.4%, p < 0.03, for Tc-99m sestamibi and Tc-99m tetrofosmin, respectively) and more often correctly id entified patients with disease in more than one coronary artery (p = 0.02). There was better defect contrast with Tc-99m sestamibi (defect/normal wall count ratios were 0.60 +/- 0.15 vs. 0.73 +/- 0.14 for Tc-99m sestamibi and Tc99m tetrofosmin, respectively, p = 0.01:, for reversible defects seen in identical segments with both agents; and 0.73 +/- 0.16 vs 0.79 +/- 0.17, r espectively p < 0.01, for reversible defects detected with either agent alo ne). There was no significant difference in diagnostic sensitivity or image quality. CONCLUSIONS These differences between two commonly used tracers may have si gnificant diagnostic and prognostic implications. (C) 2001 by the American College of Cardiology.