NUCLEAR CARDIOLOGY Prediction of Functional Outcome after Myocardial

We determined the predictive value of combined beta-methyl iodo-phenyl pentadecanoic acid (BMIPP) and sestamibi scintigraphy for the functional outcome after myocardial infarction and compared the value of this approach with dobutamine echocardiography. Methods: Rest BMIPP, rest sestamibi and low-dose dobutamine echocardiographic studies were obtained in 18 patients 4 to 10 days after infarction (mean 6.7 ±2.0 days). Six months later, a rest echocardiographic study was performed to assess functional out come. Results: Wall motion improved in 27/33 segments (82%) which showed mismatching but not in 19/21 segments (90%) with matched defects (p < 0.001). The accuracy of combined BMIPP and sestamibi SPECT in predicting segmental functional outcome was higher (85%) than that of sestamibi uptake alone (77%). Wall motion improved in 16/20 segments (80%) showing contractile reserve and not in 21/34 segments (63%) with the negative dobut amine test, giving an accuracy of 69 % for dobutamine echocardi ography. Combination of the two techniques resulted in higher positive (94%) and negative predictive values (94%). Conclusion: Mismatching of BMIPP and sestamibi uptake is predictive for long-term functional recovery after acute myocardial infarction. In contrast, segments with matched defects contain only scar tissue. Combined BMIPP and sestamibi scintigraphy offers increased ac curacy compared to dobutamine echocardiography. Key Words: myocardial viability;fatty acids; technetium-99m-ses-tamib