Impact of regional ventricular function, geometry, and dobutamine stress on quantitative 99mTc-sestamibi defect size

Abstract

Background. Serial myocardial perfusion imaging with 99mTc-sestamibi (MIBI) was used to evaluate infarct risk area and salvage after thrombolysis. The purpose of this investigation was to determine whether changes in MIBI defect size observed after reperfusion may result in part from distortion of regional and global left ventricular geometry. Methods and Results. Twenty-five open-chest dogs were subjected to either 15 minutes (groups 1A and 1B) or 3 hours (group 2) of left anterior descending coronary artery occlusion followed by 3 hours of reperfusion. MIBI was injected before occlusion (group 1A) or during occlusion (groups 1B and 2), and serial ECG-gated planar imaging was performed. Dobutamine was infused after 3 hours of reperfusion (groups 1B and 2) to transiently alter left ventricular size and function. Perfusion defect magnitude (DM) and extent (DE) were serially quantified with circumferential profile analysis of end-systolic (ES), end-diastolic (ED), and summed images. Flow was assessed with radiolabeled microspheres and correlated with myocardial MIBI activity. Myocardial thickening was assessed in the risk area with sonomicrometers. In group 1A dogs, ischemic dyskinesis produced large artifactual quantitative MIBI defects on ES images (DM, 9.3±1.3; DE, 27.8±6.0) that were significantly smaller on ED images (DM, 4.5±0.9, P