Quantification of 99Tcm-sestamibi and 123I-BMIPP uptake for predicting functional outcome in chronically ischaemic dysfunctional myocardium.

Little is known about the usefulness of free fatty acid scintigraphy for assessing viability in chronic ischaemic heart disease. To investigate this, we quantified the uptake of 99Tcm-sestamibi and 123I-BMIPP at rest twice within 6 months in 20 patients with chronic ischaemic left ventricular dysfunction and infarction. Four patterns of the relative distribution of both tracers were observed and classified as normal, mismatched, matched and scar. The proportion of the left ventricular surface corresponding to each pattern was expressed as the percentage of the total surface using a polar map. Between the two studies, the patients either underwent revascularization or were treated conservatively. The quantitative results were compared with those of dobutamine stress echocardiography (DSE) in arterial territories with resting contractile dysfunction and correlated with the evolution of regional and global function at follow-up. At baseline, 25 arterial territories were analysed. Using sestamibi, on average one-third of their surface was considered to be normally perfused. No clear association was found between the percent normally perfused surface and the DSE findings. Adding BMIPP and using a value of > 7% of the arterial surface with BMIPP lower than sestamibi (mismatch) as the cut-off for the significance of viability, 14 of 18 mismatched regions were considered viable by DSE, and six of seven with < 7% mismatched surface or matching were not. Fifteen patients were viable, of whom 13 were revascularized (16 territories). At follow-up, global function improved in 11 of the 15 viable patients, all in the revascularized group. Regional improvement was noted in 11 of 16 revascularized territories, and was associated with a significant increase in sestamibi and BMIPP uptake and in the percent normally perfused myocardial surface. In the five patients without significant viability, no functional deterioration or changes in the quantitative parameters were observed during treatment. The results suggest that quantitative analysis of the uptake of sestamibi and BMIPP is a reliable method to objectively assess the presence of myocardial viability in chronic ischaemic heart disease and to predict functional improvement after revascularization.