Assessment of myocardial viability using F-18 fluorodeoxyglucose/Tc-99m sestamibi dual-isotope simultaneous acquisition SPECT: comparison with Tl-201 stress-reinjection SPECT.

Background: This study compared technetium 99m sestamibi/fluorine 18 fluorodeoxyglucose dual-isotope simultaneous acquisition (DISA) with stress-reinjection thallium 201 single photon emission computed tomography (SPECT) with regard to their ability to detect myocardial viability.

Methods And Results: The study cohort consisted of 42 angiographically significant coronary artery disease patients with symptomatic congestive heart failure or regional wall motion abnormalities. In total, 398 dysfunctional segments in 40 patients were analyzed (2 patients were excluded because of poor-quality F-18 fluorodeoxyglucose images). Of the segments, 217 were diagnosed as viable and 144 as nonviable by both DISA and Tl-201, 33 were viable by DISA but nonviable by Tl-201, and 4 were viable by Tl-201 but nonviable by DISA. Most discrepancies were in the inferior wall. Of the 40 patients, 16 underwent revascularization. From the follow-up results for the 105 dysfunctional segments in these 16 patients, DISA viability appears to be a significant predicting factor (P = .014) for functional recovery after revascularization statistically whereas Tl-201 viability does not (P = .09).

Conclusion: Our study suggests that DISA viability provides more accurate prediction of postrevascularization functional recovery than Tl-201 viability. Given the small number of patients who underwent revascularization, the superiority of DISA over Tl-201 in detecting myocardial viability may be firmly established by further study on a large scale for patients with profound left ventricular dysfunction.