American Heart Journal
Volume 145, Issue 6 , Pages 952-961 , June 2003

Role of single photon emission computed tomography imaging in the evaluation of therapy for angina pectoris

  • Amar D Patel, MD

      Affiliations

    • Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala, USA
  • ,
  • Ami E Iskandrian, MD, FACC, FAHA

      Affiliations

    • Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala, USA
    • Corresponding Author InformationReprint requests: Ami E. Iskandrian, MD, Distinguished Professor of Medicine and Radiology, 318 LHRB, 1900 University Blvd, Birmingham, AL 35294-0006, USA.

References 

  1. Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation. 2000;101:1465–1478
  2. Gibbons RJ, Miller TD, Christian TF. Infarct size measured by single photon emission computed tomographic imaging with 99m-Tc-sestamibi. Circulation. 2000;101:101–108
  3. In:  Iskandrian AE,  Verani MS editor. Nuclear cardiac imaging (principles and applications). 2nd ed. Philadelphia: FA Davis; 1996;
  4. Iskandrian AS, Verani MS, Heo J. Pharmacologic stress testing (mechanism of action, hemodynamic responses, and results in detection of coronary artery disease). J Nucl Cardiol. 1994;1:94–111
  5. DePuey EG, Garcia EV. Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. J Nucl Med. 1989;30:441–449
  6. Germano G, Chua T, Kavanagh PB, et al.  Detection and correction of patient motion in dynamic and static myocardial SPECT using a multi-detector camera. J Nucl Med. 1993;34:1349–1355
  7. Narula J, Dawson MS, Singh BK, et al.  Noninvasive characterization of stunned, hibernating, remodeled and nonviable myocardium in ischemic cardiomyopathy. J Am Coll Cardiol. 2000;36:1913–1919
  8. Sharir T, Germano G, Waechter PB, et al.  A new algorithm for the quantitation of myocardial perfusion SPECT. II (validation and diagnostic yield). J Nucl Med. 2000;41:720–727
  9. Mahmarian JJ, Moye LA, Verani MS, et al.  High reproducibility of myocardial perfusion defects in patients undergoing serial exercise thallium-201 tomography. Am J Cardiol. 1995;75:1116–1119
  10. Alazraki NP, Krawczynska EG, DePuey EG, et al.  Reproducibility of thallium-201 exercise SPECT studies. J Nucl Med. 1994;35:1237–1244
  11. Prigent FM, Berman DS, Elashoff J, et al.  Reproducibility of stress redistribution thallium-201 SPECT quantitative indexes of hypoperfused myocardium secondary to coronary artery disease. Am J Cardiol. 1992;70:1255–1263
  12. Burkhoff D, Jones JW, Becker LC, et al.  Variability of myocardial perfusion defects assessed by thallium-201 scintigraphy in patients with coronary artery disease not amenable to angioplasty or bypass surgery. J Am Coll Cardiol. 2001;38:1033–1039
  13. Burkhoff D, Schmidt S, Schulman SP, et al.  Transmyocardial laser revascularisation compared with continued medical therapy for treatment of angina pectoris (a prospective randomised trial). Lancet. 1999;354:885–890
  14. Whittaker P, Kloner RA. Transmural channels as a source of blood flow to ischemic myocardium?. Circulation. 1997;95:1357–1359
  15. Kohmoto T, Argenziano M, Yamamoto N, et al.  Assessment of transmyocardial perfusion in alligator hearts. Circulation. 1997;95:1585–1591
  16. Mirhoseini M, Cayton MM. Revascularization of the heart by laser. J Microsurg. 1981;2:253–260
  17. Yamamoto N, Kohmoto T, Gu A, et al.  Angiogenesis is enhanced in ischemic canine myocardium by transmyocardial laser revascularization. J Am Coll Cardiol. 1998;31:426–433
  18. Sayeed-Shah U, Mann MJ, Martin J, et al.  Complete reversal of ischemic wall motion abnormalities by combined use of gene therapy with transmyocardial laser revascularization. J Thorac Cardiovasc Surg. 1998;116:763–769
  19. Horvath KA, Smith WJ, Laurence RG, et al.  Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization. J Am Coll Cardiol. 1995;25:258–263
  20. Diegeler A, Schneider J, Lauer B, et al.  Transmyocardial laser revascularization using the Holium-YAG laser for treatment of end stage coronary artery disease. Eur J Cardiothorac Surg. 1998;13:392–397
  21. Lauer B, Junghans U, Stahl F, et al.  Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease. J Am Coll Cardiol. 1999;34:1663–1670
  22. Kavanagh GJ, Whittaker P, Prejean CA, et al.  Dissociation between improvement in angina pectoris and myocardial perfusion after transmyocardial revascularization with an excimer laser. Am J Cardiol. 2001;87:229–231
  23. Schneider J, Diegeler A, Krakor R, et al.  Transmyocardial laser revascularization with the holium (YAGlaser: loss of symptomatic improvement after 2 years). Eur J Cardiothorac Surg. 2001;19:164–169
  24. Horvath KA, Cohn LH, Cooley DA, et al.  Transmyocardial laser revascularization; results of a multicenter trial with transmyocardial laser revascularization used as a sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg. 1997;113:645–654
  25. Milano A, Pratlai S, Tartarini G, et al.  Early results of transmyocardial revascularization with a holium laser. Ann Thorac Surg. 1998;65:700–704
  26. Allen KB, Dowling RD, Fudge TL, et al.  Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med. 1999;341:1029–1036
  27. Frazier OH, March RJ, Horvath KA, et al.  Transmyocardial revascularization with a carbon dioxide laser in patients with end-stage coronary artery disease. N Engl J Med. 1999;341:1021–1028
  28. Schofield PM, Sharples LD, Caine N, et al.  Transmyocardial revascularisation in patients with refractory angina (a randomised controlled trial). Lancet. 1999;353:519–524
  29. Horvath KA, Mannting P, Cummings N, et al.  Transmyocardial laser revascularization (operative techniques and clinical results at two years). J Thorac Cardiovasc Surg. 1996;111:1047–1053
  30. Cooley DA, Frazier OH, Kadipasaoglu KA, et al.  Transmyocardial laser revascularization (clinical experience with twelve-month follow-up). J Thorac Cardiovasc Surg. 1996;111:791–799
  31. Frazier OH, Cooley DA, Kadipasaoglu KA, et al.  Myocardial revascularization with laser. Circulation. 1995;92(Suppl 2): II-58–65
  32. Nagele H, Stubbe HM, Nienaber C, et al.  Results of transmyocardial laser revascularization in non-revascularizable coronary artery disease after 3 years follow-up. Eur Heart J. 1998;19:1525–1530
  33. Vincent JG, Bardos P, Kruse J, Maass D. End stage coronary disease treated with the transmyocardial CO2 laser revascularisation (a chance for the “inoperable” patient). Eur J Cardiothorac Surg. 1997;11:888–894
  34. Agarwal A, Ajit M, Kurian VM, et al.  Transmyocardial laser revascularization (early results and 1-year follow-up). Ann Thorac Surg. 1999;67:432–436
  35. Lee LY, O’Hara MF, Finnin EB, et al.  Transmyocardial laser revascularization with excimer laser (clinical results at 1 year). Ann Thorac Surg. 2000;70:498–503
  36. Stoll HP, Hutchins GD, Fain RL, et al.  Transmyocardial laser revascularization (TMR) induces regional myocardial denervation. (abstract) Circulation. 1998;98(Suppl 1):349
  37. Kohomoto T, Fisher PE, Gu A, et al.  Physiology, histology, and 2 week morphology of acute transmyocardial channels made with a CO2 laser. Ann Thorac Surg. 1997;63:1275–1283
  38. Krabatsch T, Schaper F, Leder C, et al.  Histological findings after transmyocardial laser revascularization. J Card Surg. 1996;11:326–331
  39. Hardy RI, Bove KE, James FW, et al.  A histologic study of laser-induced transmyocardial channels. Lasers Surg Med. 1987;6:563–573
  40. Gassler N, Wintzer HO, Stubbe HM, et al.  Transmyocardial laser revascularization (histological features in human nonresponder myocardium). Circulation. 1997;95:371–375
  41. Schaper W, Ito WD. Molecular mechanisms of coronary collateral vessel growth. Circ Res. 1996;79:911–919
  42. Flier JS, Underhill LH. Clinical applications of research on angiogenesis. N Engl J Med. 1995;333:1757–1763
  43. Isner JM, Asahara T. Angiogenesis and vasculogenesis as therapeutic stategies for postnatal neovascularization. J Clin Invest. 1999;103:1231–1236
  44. Lee SH, Wolf PL, Escudero R, et al.  Early expression of angiogenesis factors in acute myocardial infarction. N Engl J Med. 2000;342:626–633
  45. Ware JA, Simons M. Angiogenesis in ischemic heart disease. Nat Med. 1997;3:158–164
  46. Takeshita S, Zheng LP, Brogi E, et al.  Therapeutic angiogenesis. J Clin Invest. 1994;93:662–670
  47. Grines CL, Watkins MW, Helmer G, et al.  Angiogenic gene therapy (AGENT) trial in patients with stable angina pectoris. Circulation. 2002;105:1291–1297
  48. Losordo DW, Vale PR, Hendel RC, et al.  Phase 1/2 placebo-controlled, double-blind, dose-escalating trial of myocardial vascular endothelial growth factor 2 gene transfer by catheter delivery in patients with chronic myocardial ischemia. Circulation. 2002;105:2012–2018
  49. Baumgartner I, Pieczek A, Manor O, et al.  Constitutive expression of ph VEGF-165 after intramuscular gene transfer promotes collateral vessel development in patients with critical limb ischemia. Circulation. 1998;97:1114–1123
  50. Tsurumi Y, Takeshita S, Chen D, et al.  Direct intramuscular gene transfer of naked DNA encoding vascular endothelial growth factor augments collateral development and tissue perfusion. Circulation. 1996;94:3281–3290
  51. Giordano FJ, Ping P, McKirnan MD, et al.  Intracoronary gene transfer of fibroblast growth factor-5 increases blood flow and contractile function in an ischemic region of the heart. Nat Med. 1996;2:534–539
  52. Harada K, Grossman W, Friedman M, et al.  Basic fibroblast growth factor improves myocardial function in chronically ischemic porcine hearts. J Clin Invest. 1994;94:623–630
  53. Battler A, Scheinowitz M, Bor A, et al.  Intracoronary injection of basic fibroblast growth factor enhances angiogenesis in infarcted swine myocardium. J Am Coll Cardiol. 1993;22:2001–2006
  54. Banai S, Jaklitsch MT, Shou M, et al.  Angiogenic-induced enhancement of collateral blood flow to ischemic myocardium by vascular endothelial growth factor in dogs. Circulation. 1994;89:2183–2189
  55. Harada K, Freidman M, Lopez JJ, et al.  Vascular endothelial growth factor administration in chronic myocardial ischemia. Am J Physiol. 1996;270:H1791–H1802
  56. Unger EF, Banai S, Shou M, et al.  Basic fibroblast growth factor enhances myocardial collateral flow in a canine model. Am J Physiol. 1994;266:H1588–H1595
  57. Lopez JJ, Edelman ER, Stamler A, et al.  Basic fibroblast growth factor in a porcine model of chronic myocardial ischemia (a comparison of angiographic, echocardiographic and coronary flow parameters). J Pharmacol Exp Ther. 1997;282:385–390
  58. Miwa-Yanagisawa A, Uchida Y, Nakamura F, et al.  Salvage of infarcted myocardium by angiogenic action of basic fibroblast growth factor. Science. 1992;257:1401–1403
  59. Sellke FW, Li J, Stamler A, et al.  Angiogenesis induced by acidic fibroblast growth factor as an alternative method of revascularization for chronic myocardial ischemia. Surgery. 1996;120:182–188
  60. Symes JF, Losordo DW, Vale PR, et al.  Gene therapy with vascular endothelial growth factor for inoperable coronary artery disease. Ann Thorac Surg. 1999;68:830–837
  61. Hendel RC, Henry TD, Rocha-Singh K, et al.  Effect of intracoronary recombinant human vascular endothelial growth factor on myocardial perfusion. Circulation. 2000;101:118–121
  62. Udelson JE, Dilsizian V, Laham RJ, et al.  Therapeutic angiogenesis with recombinant fibroblast growth factor-2 improves stress and rest myocardial perfusion abnormalities in patients with severe symptomatic chronic coronary artery disease. Circulation. 2000;102:1605–1610
  63. Vale PR, Losordo DW, Milliken CE, et al.  Left ventricular electromechanical mapping to assess efficacy of phVEGF-165 gene transfer for therapeutic angiogenesis in chronic myocardial ischemia. Circulation. 2000;102:965–974
  64. Vale PR, Losordo DW, Milliken CE, et al.  Randomized, single-blind, placebo-controlled pilot study of catheter-based myocardial gene transfer for therapeutic angiogenesis using left ventricular electromechanical mapping in patients with chronic myocardial ischemia. Circulation. 2001;103:2138–2143
  65. Losordo DW, Vale PR, Symes JF, et al.  Gene therapy for myocardial angiogenesis. Initial clinical results with direct myocardial injection of phVEGF-165 as sole therapy for myocardial ischemia. Circulation. 1998;98:2800–2804
  66. Rosengart TK, Lee LY, Patel SR, et al.  Phase I assessment of direct intramyocardial administration of an adenovirus vector expressing VEGF121 cDNA to individuals with clinically significant severe coronary artery disease. Circulation. 1999;100:468–474
  67. Sellke FW, Laham RJ, Edelman ER, et al.  Therapeutic angiogenesis with basic fibroblast growth factor (technique and early results). Ann Thorac Surg. 1998;65:1540–1544
  68. Laham RJ, Sellke FW, Edelman ER, et al.  Local perivascular delivery of basic fibroblast growth factor in patients undergoing coronary bypass surgery. Circulation. 1999;100:1865–1871
  69. Scandinavian Simvastatin Survival Study Group . Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease (the Scandinavian Simvastatin Survival Study). Lancet. 1994;344:1383–1389
  70. Sacks FM, Pfeffer MA, Moye LA, et al.  The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001–1009
  71. Pitt B, Mancini GBJ, Ellis SG, et al.  Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I) (reduction in atherosclerosis progression and clinical events). J Am Coll Cardiol. 1995;26:1133–1139
  72. Waters D, Higginson L, Gladstone P, et al.  Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography. Circulation. 1994;89:959–968
  73. Jukema JW, Brushke AVG, van Boven AJ, et al.  Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. Circulation. 1995;91:2528–2540
  74. Blankenhorn DH, Azen SP, Kramsch DM, et al.  Coronary angiographic changes with lovastatin therapy. Ann Intern Med. 1993;119:969–976
  75. Leung WH, Lau CP, Wong CK. Beneficial effect of cholesterol-lowering therapy on coronary endothelium-dependent relaxation in hypercholesterolemic patients. Lancet. 1993;341:1496–1500
  76. Treasure CB, Klein JL, Weintraub WS, et al.  Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med. 1995;332:481–487
  77. O’Driscoll G, Green D, Taylor RR. Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation. 1997;95:1126–1131
  78. Egashira K, Hirooka Y, Kai H, et al.  Reduction in serum cholesterol with pravastatin improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. Circulation. 1994;89:2519–2524
  79. Rim SJ, Leong-Poi H, Linder JR, et al.  Decrease in coronary blood flow reserve during hyperlipidemia is secondary to an increase in blood viscosity. Circulation. 2001;104:2704–2709
  80. Eichstadt HW, Abletshauser CB, Stork T, et al.  Beneficial effects of fluvastatin on myocardial blood flow at two time-points in hypercholesterolemic patients with coronary artery disease. J Cardiovasc Pharmacol. 2000;35:735–740
  81. Mostaza JM, Gomez MV, Gallardo F, et al.  Cholesterol reduction improves myocardial perfusion abnormalities in patients with coronary artery disease and average cholesterol levels. J Am Coll Cardiol. 2000;35:76–82
  82. Gould KL, Martucci JP, Goldberg DI, et al.  Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease. Circulation. 1994;89:1530–1538
  83. Schwartz RG, Pearson TA. Can single photon emission computed tomography myocardial perfusion imaging monitor the potential benefit of aggressive treatment of hyperlipidemia?. J Nucl Cardiol. 1997;4:555–568
  84. Yokoyama I, Yonekura K, Inoue Y, et al.  Long-term effect of simvastatin on the improvement of impaired myocardial flow reserve in patients with familial hypercholesterolemia without gender variance. J Nucl Cardiol. 2001;8:445–451
  85. Chaitman BR, Stone PH, Knatterud GL, et al.  Asymptomatic cardiac ischemia pilot (ACIP) study (impact of anti-ischemia therapy on 12-week rest electrocardiogram and exercise test outcomes). J Am Coll Cardiol. 1995;26:585–593
  86. Pepine CJ, Lopez LM, Bell DM, et al.  Effects of intermittent transdermal nitroglycerin on occurrence of ischemia after patch removal (results of the second transdermal intermittent dosing evaluation study (TIDES-II)). J Am Coll Cardiol. 1997;30:955–961
  87. Meluzin J, Zeman K, Stetka F, et al.  Effects of nifedipine and diltiazem on myocardial ischemia in patients with severe stable angina pectoris treated with nitrates and beta-blockers. J Cardiovasc Pharmacol. 1992;20:864–869
  88. Messin R, Karpov Y, Baikova N, et al.  Short- and long-term effects of molisidomine retard and molsidomine nonretard on exercise capacity and clinical status in patients with stable angina (a multicenter randomized double-blind crossover placebo-controlled trial). J Cardiovasc Pharmacol. 1998;31:271–276
  89. Rajaratnam R, Brieger DB, Hawkins R, et al.  Attenuation of anti-ischemic efficacy during chronic therapy with nicorandil in patients with stable angina pectoris. Am J Cardiol. 1999;83:1120–1124
  90. Hamer AWF. Placebo effect of nitrate monotherapy for myocardial ischemia. Am J Cardiol. 1992;70:1238–1242
  91. Singh N, Mironov D, Goodman S, et al.  Treatment of silent ischemia in unstable angina (a randomized comparison of sustained-release verapamil versus metoprolol). Clin Cardiol. 1995;18:653–658
  92. DeMots H, Glasser SP. Intermittent transdermal nitroglycerin therapy in the treatment of chronic stable angina. J Am Coll Cardiol. 1989;13:786–793
  93. Rossetti E, Luca C, Bonetti F, et al.  Transdermal nitroglycerin reduces the frequency of anginal attacks but fails to prevent silent ischemia. J Am Coll Cardiol. 1993;21:337–342
  94. Bridges AB, Kennedy N, McNeill GP, et al.  The effect of atenolol on dipyridamole 201-Tl myocardial perfusion tomography in patients with coronary artery disease. Nucl Med Comm. 1992;13:41–46
  95. Narahara K, Thompson CJ, Hazen JF, et al.  The effect of beta blockade on single photon emission computed tomographic (SPECT) thallium-201 images in patients with coronary disease. Am Heart J. 1989;117:1030–1035
  96. Hockings B, Saltissi S, Croft DN, et al.  Effect of beta adrenergic blockade on thallium-201 myocardial perfusion imaging. Br Heart J. 1983;49:83–89
  97. Rainwater J, Steele P, Kirch D, et al.  Effect of propanolol on myocardial perfusion images and exercise ejection fraction in men with coronary artery disease. Circulation. 1982;65:77–81
  98. Marie PY, Danchin N, Branly F, et al.  Effects of medical therapy on outcome assessment using exercise thallium-201 single photon emission computed tomography imaging. J Am Coll Cardiol. 1999;34:113–121
  99. Billinger M, Seiler C, Fleisch M, et al.  Do beta-adrenergic blocking agents increase coronary flow reserve?. J Am Coll Cardiol. 2001;38:1866–1871
  100. Steele P, Sklar J, Kirch D, et al.  Thallium-201 myocardial imaging during maximal and submaximal exercise (comparison of submaximal exercise with propanolol). Am Heart J. 1983;106:1353–1357
  101. Mahmarian JJ, Fenimore NL, Marks GF, et al.  Transdermal nitroglycerin patch therapy reduces the extent of exercised-induced myocardial ischemia (results of a double-blind, placebo-controlled trial using quantitative thallium-201 tomography). J Am Coll Cardiol. 1994;24:25–32
  102. Goller V, Clausen M, Henze E, et al.  Reduction of exercise-induced myocardial perfusion defects by isosorbide-5-nitrate (assessment using quantitative Tc-99m-MIBI-SPECT). Coron Art Dis. 1995;6:245–249
  103. Lewin HC, Hachamovitch R, Harris AG, et al.  Sustained reduction of exercise perfusion defect extent and severity with isosorbide mononitrate (Imdur) as demonstrated by means of technetium 99m sestamibi. J Nucl Cardiol. 2000;7:342–353
  104. Yamazaki J, Ohsawa H, Uchi T, et al.  Study of the efficacy of nicorandil in patients with ischemic heart disease using exercise-Tl-201 myocardial tomography. Eur J Clin Pharmacol. 1993;44:211–217
  105. Zervos G, Zusman RM, Swindle LA, et al.  Effects of nifedipine on myocardial blood flow and systolic function in humans with ischemic heart disease. Coron Artery Dis. 1999;10:185–194
  106. Zimmermann R, Tillmanns H, Kapp M, et al.  Reduction of myocardial ischemia by gallopamil (a dual-isotope study with thallium-201 and iodine-123 phenylpentadecanoic acid). J Cardiovasc Pharmacol. 1992;20(Suppl. 7):S40–S47
  107. Rousseau MF, Melin J, Benedict CR, et al.  Effects of nisoldipine therapy on myocardial perfusion and neuro-hormonal status in patients with severe ischemic left ventricular dysfunction. Eur Heart J. 1994;15:957–964
  108. Dakik HA, Kleiman NS, Farmer JA, et al.  Intensive medical therapy versus coronary angioplasty for suppression of myocardial ischemia in survivors of acute myocardial infarction. Circulation. 1998;98:2017–2023
  109. Sharir T, Rabinowitz B, Livschitz S, et al.  Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 single photon emission computed tomographic myocardial perfusion imaging in patients taking antianginal drugs. J Am Coll Cardiol. 1998;31:1540–1546
  110. Stegaru B, Loose R, Keler H, et al.  Effects of long-term treatment with 120 mg of sustained-release isosorbide dinitrate and 60 mg of sustained-release nifedipine on myocardial perfusion. Am J Cardiol. 1988;61:74E–77E
  111. Rinaldi CA, Linka AZ, Masani ND, et al.  Randomized, double-blind crossover study to investigate the effects of amlodipine and isosorbide mononitrate on the time course and severity of exercise-induced myocardial stunning. Circulation. 1998;98:749–756

PII: S0002-8703(03)00088-7

doi: 10.1016/S0002-8703(03)00088-7

American Heart Journal
Volume 145, Issue 6 , Pages 952-961 , June 2003