Non-invasive detection of ischaemia and intervention cardiology Oral abstract session 14:00-15:30 3.1 Prognostic value of myocardial perfusion-function imaging (gated-SPECT) in symptom- atic and asymptomatic patients after percutaneous coronary intervention. M. Marco Mazzanti 1 , M. Marini 2 , M. Serenelli 2 , G.P. Perna. 21 Lancisi Heart Hospital, Nuclear cardiology, Ancona, Italy, 2 Ospedali Riuniti, Cardiology “Lancisi”, Ancona, Italy Previously reported literature demonstrated similar rate of ischemia, detected by myocardial perfusion imaging (MPI), in a a population of symptomatic and asymptomatic patients (pts) PCI + stenting. Aim of this study was to evaluate the prognostic value of gated-MPI in predicting major adverse cardiovascular events (MACE) after PCI in these pts. Methods: In the period 2002-2003 we evaluated 573 pts after stenting PCI, who performed stress/rest gated MPI and who has been followed-up for 215 (8-26) months to determine the presence of MACE (cardiac death, myocardial infarction, PCI or CABG). The proportion of symtomatic pts was 41% (235 pts). To perform gated-SPECT study we adopted a dual-day stress/rest protocol. Both post-exercise and resting images were gated and acquired 20-30 minutes after injection of technetium 99m-tetrofosmin using a dual-head camera. Perfusion quantitation,left ventricular volumes and global post-stress (Ps) and rest (R) left ventricular ejection fraction (LVEF) were automatically calculated with the use of Autoquant® software package. All clinical, risk factors for CAD, stress/rest and perfusion-function variables were included in the univariate analysis. Results: MACE were presented as follow: cardiac death in 13 (2.3%), myocardial infarction in 18 (3.1%), PCI in 52 (9.0%) and CABG in 22 (3.8%). Of note MACE rate was similar in symptomatic and asymptomatic patients [44/235 (19%) vs. 61/338 (18%), p=NS].The results of MPI variables are presented in Table 1. In multivariate analysis, presence of ischemia represented by SDS and/or significative reduction (10%) of post-stress LVEF were the most important independent predictor of MACE (odds ratio 6.27, CI 95% 3.12-15.6, p0.001). Conclusion: The presence of myocardial ischemia by MPI performed after PCI predicts worse outcome during 2 year of follow-up in both symptomatic and asymptomatic patients. Table n.1 MACE n=105 (18.3%) No MACE n=468 (81.7%) p Ischemia 78 (74.2) 231 (49.5) 0.01 SSS 13.5  3.1 10.6  1.7 0.03 SDS 10.3  2.5 3.2  0.5 0.001 Ps-LVEF 0.43  0.11 0.56  0.16 0.001 R-LVEF 0.53  0.13 0.55  0.11 NS 3.2 High-dose dobutamine stress myocardial fatty acid imaging can identify transient contractile dysfunction underestimated by stress perfusion imaging. A. Akiyoshi Hashimoto 1 , N. Kokubu 1 , K. Nishizato 1 , S. Yuda 1 , K. Uno 1 , T. Nakata 1 , K. Tsuchihashi 1 , K. Shimamoto 1 , K. Nagao 2 , T. Takada. 31 Sapporo Medical University, 2nd. Depertment of Internal Medicine, Sapporo, Japan, 2 Sapporo Cardiovascular Hospital, Cardiology, Sapporo, Japan, 3 Hakodate Goryokaku Hospital, Cardiology, Hakodate, Japan Myocardial fatty acid metabolism is so susceptible to transient myocardial ischemia that myocardial fatty acid metabolism is impaired persistently even after recovery from perfusion abnormality. We hypothesized that stress myocardial fatty acid imaging can more precisely identify contractile dysfunction induced by transient ischemia, including demand ischemia, than does stress perfusion imaging. To test this hypothesis, thallium-201 (Tl)/I-123-beta-methyl iodophenylpentadecanoic acid (BMIPP) dual SPECT (DDS) and two-dimensional echocardiography (DSE) were performed simultaneously using a high-dose dobutamine in 25 patients with stable coronary artery disease (619 years, 18 males, 7 females). DDS and DSE images were obtained 20 min (stress-BMIPP, Tl) and 4 hours (rest- BMIPP, Tl) after intravenous infusion of dobutamine at increments of 5, 10, 20, 30, 40 micro-g/kg/ min with a 3 min-interval. Reduced myocardial uptake of Tl or BMIPP was quantified using a polar map technique as a severity score (SS). Regional wall motion abnormality (WMA) was evaluated semiquantitatively at rest and at a high-dose (40 micro-g/kg/min) dobutamine infusion. Stress-BMIPP SS was signif- icantly greater than stress-Tl SS (19399 vs. 17189, p0.05). At a high-dose test, stress-BMIPP SS correlated more clearly with WMA (y=0.03x-0.87, r=0.59, p0.05) than did stress-Tl SS (y=0.03x+0.54, r=0.46, p0.05). The deterioration in WMA induced by dobutamine (stress-WMA minus rest-WMA) significantly correlated with the difference in BMIPP uptake between stress and rest-SS (y=0.02x+0.19, r=0.45, p0.05). Thus, stress-induced transient impairment of contractile function and fatty acid metabolism may reflect imbalance between increased oxygen demands and coronary flow reserve rather than relative abnor- mality of tracer distribution in myocardium. 3.3 Clinical efficacy of distal embolic protection device (PercuSurge GuardWire) in proximal right coronary artery during acute myocardial infarction estimated by gated myocardial perfusion SPECT. A. Akira Sato 1 , K. Aonuma 2 , T. Nozato 1 , Y. Yokoyama 1 , A. Takahashi 1 , M. Isobe 3 , M. Hiroe. 41 Yokosuka Kyosai General Hospital, Cardiovascular Center, Yokosuka, Japan, 2 University of Tsukuba, Cardiovascular Medicine, Tsukuba, Japan, 3 Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan, 4 Inter- national Medical Center of Japan, Nephrology and Cardiology Division, Tokyo, Japan The no-reflow phenomenon has been associated with poor clinical outcomes in patients with acute myocardial infarction(AMI). The aim of this study is to investigate the clinical efficacy of distal embolic protection device(PercuSurge GuardWire:GW) treated in proximal right coronary artery during inferior AMI utilizing gated myocardial perfusion SPECT. Methods:We evaluated 65 consecutive patients with inferior AMI, 30 patients treated by primary stenting with GW(Group P), 35 patients by primary stenting without GW(Group N). Gated 99mTc-tetrofosmin SPECT was performed at acute phase(1 days after admission) and 6 months later. The left ventricle was divided into 17 segments and total defect scores(TDS) were calculated as summation of defect scores(0=normal to 3=severe defect). LVEF, EDV and ESV were measured by QGS program. Results:There were no differences in clinical and angiographical characteristics, time to reperfusion between both groups. No differences were observed in max CK-MB(P:274212 vs N:282219U/l), however TIMI-3 flow grade was more frequently observed in Group P than Group N(83.3 vs 64.2%, p0.05). Myocardial blush grade 3 was also higher in Group P than Group N(58.3 vs 42.6%, p0.05). LVEF and TDS in Group P significantly improved from 52.62.4% to 59.01.9%and 11.14.1 to 6.53.2, respectively, whereas LVEF and TDS in Group N did not changed from 51.62.8% to 50.83.3% and 11.91.4 to 8.81.4. Conversely, LVEDV in Group N significantly increased from 97.4 7.6ml to 1058.9ml, whereas those in Group P did not changed from 96.5  4.5ml to 93.2  5.3ml.(Figure) Conclusions:The GuardWire distal embolic protection device is a useful tool for preventing distal embolization and preserving left ventricular function during recovery phase after inferior AMI. Changes of LVEF,EDV and TDS(Gated SPECT) 3.4 Intravascular ultrasound and coronary pressure measurements in patients with scintigraphic myocardial ischemia and non-significant coronary lesions. G. De Leon 1 , J. Rodes-Cabau 2 , J. Candell-Riera 1 , S. Santiago Aguade ´-Bruix 1 , J. Castell- Conesa 1 , J. Angel 1 , A. Soto 1 , I. Anı ´varro 1 , JC. Tardif 1 , J. Soler-Soler. 11 Vall d’Hebron, Nuclear Medicine, Barcelona, Spain, 2 Montreal Heart Institute, Cardiology, Montreal, Canada Several studies have demonstrated a high correlation between myocardial ischemia and severity of coronary lesions determined by both intravascular ultrasound (IVUS) and fractional flow reserve (FFR) measurements. However, their value for the assessment of mild coronary stenoses associated with myocardial perfusion abnormalities has not been well studied. Aim of the study. To compare the results of myocardial perfusion, determined by exercise myocardial SPECT, with IVUS and FFR in patients with angiographically mild coronary stenosis (50% diameter stenosis by quantitative coronary angiography) Methods. Forty-eight stable coronary patients (mean age: 61  11 years, 6 females) were studied. All of them had mild coronary stenosis in the proximal-mid segment of at least one coronary artery and all of them underwent maximal exercise myocardial 99mTc-tetrofosmin SPECT 24 hours before coronary angiography. IVUS and FFR lesion evaluations were performed in all cases. IVUS measurements included: lesion lumen area (LA) and % plaque area (external elastic membrane area minus LA/external elastic membrane area x100) (PA), assessed by 3-D IVUS in a 30-mm coronary segment including the lesion. Results. A total of 53 coronary lesions were studied, with a mean % diameter stenosis (DS) of 35  8%. Myocardial ischemia was demonstrated by exercise myocardial SPECT in 10 patients (12 myocardial regions) without statistical differences compared to those without ischemia. The presence of ischemia was associated with a higher PA as evaluated by IVUS (67  8% vs 60  9%, p=0.01). LA and PV were not significantly different between patients with and without ischemia (4.59  1.64 mm2 vs 5.61  2.46 mm2; 207  44 mm3 vs 197  68 mm3, p=ns). FFR values did not differ in the presence or absence of ischemia (0.90  0.06 vs 0.92  0.07, p=ns). Conclusions. Higher plaque burden as determined by IVUS could partially explain the presence of myocardial ischemia in cases with angiographically non-significant coro- nary lesions. However, the high FFR values associated with these lesions suggest that other mechanisms such as microvascular dysfunction might also account for myocardial ischemia in these patients. M O N D A Y M A Y 9 M O N D A Y M A Y 9 Journal of Nuclear Cardiology S16 Monday, May 9, 2005