To identify and quantify the amount of viable hibernating myocardium in patients with chronic coronary artery disease, resting
201Tl single photon emission computed tomography (SPECT) was compared with
99mTc-methoxyisobutyl isonitrile (MIBI) SPECT after nitrate infusion (nitrate-
99mTc-MIBI) and
201Tl SPECT after
201Tl with glucose-insulin-potassium infusion (
201Tl-GIK) in 25 patients. Twenty-one patients also underwent completely left ventriculography beforehand and 5±4 months afterwards. SPECT images were divided into 9 segments and scored visually from 0 (normal uptake) to 3 (absent). The defect score was calculated as the summation of the total scores (TDS) in each patient. The TDS of nitrate-
99mTc-MIBI images (6.3±4.3) and
201Tl-GIK images (5.8±4.2) were significantly lower than the 7.4±4.3 of resting
201Tl images (p<0.01). Based on the improvement of wall motion after coronary revascularization, the sensitivity of
201Tl-GIK imaging (85%) was significantly higher (p<0.05), and that of nitrate-
99mTc-MIBI imaging (79%) also tended to be higher (p=0.08), than that of
201Tl imaging (62%) in detecting viable myocardium. The specificity of the 3 methods was almost the same. The nitrate-
99mTc-MIBI and
201Tl-GIK methods were more useful than the resting
201Tl method for evaluating viable hibernating myocardium. Furthermore, the
201Tl-GIK method may provide a more accurate estimate of the amount of viable myocardium than the nitrate-
99mTc-MIBI method.
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