Myocardial Rest/Stress Study For Assessment Of Ischaemia (SPECT - with Tc99m SESTAMIBI)
Assessment of regional blood flow to the LV myocardium at rest and after the stress (bike ergometer), or Persantin IV (for patients with LBBB, or unable to exercise) or Dobutamine I.V.
Indications
Angina on exertion with equivocal ECG stress test. False positive ECG stress test. Angina post A.M.I. Angina with LBBB. Assessment before major surgery in peripheral vascular disease (with Persantin stress test).
Preparation
Cessation of B-blockers 72 hours prior to the test. Other medicines, if possible, should not be taken on the morning of the test. Tea and coffee must be stopped for 24 hours.before stress (due to possible use of Persantin) ,In patients treated for GO reflux caffeine should be stopped for 3 days.
Contraindications
Persantin is contraindicated in asthma or COPD (Dobutamine may be used instead). In patients with weight over 140 kg study can’t be done (SPECT table restrictions).
Procedure
- Tc99m SESTAMIBI 15 mCi I.V. at rest, followed with SPECT Scan 30 minutes later.
- Bike ergometer stress test (or Persantin infusion) with Tc99m SESTAMIBI (35 mCi) injected at maximum stress level followed with SPECT Scan 60 minutes later, with gated acquisition providing analysis of wall motion and thickening and measurement of LV EF.and End Diastolic and End Systolic Volumes (mls), polar maps of EF, wall motion and wall thickening.
Attention
To local patients more convenient two days REST-STRESS protocol may be offered.
58 yo man, with SOB and no chest pain after 6 min on bike ergometer (100W). Significant perfusion defect in anterior wall and apex post stress. Below: Statistical significance of ischemia in comparison to control group.
