Myocardial perfusion imaging with 99mTc tetrofosmin: Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial

Barry L. Zaret, Pierre Rigo, Frans J T Wackers, Robert Hendel, Simon H. Braat, Ami S. Iskandrian, Bangalore S. Sridhara, Diwakar Jain, Roland Itti, Aldo N Serafini, Michael L. Goris, Avijit Lahiri

Research output: Contribution to journalArticle

169 Citations (Scopus)

Abstract

Background: Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies. Methods and Results: Two hundred fifty-two patients with suspected coronary artery disease were enrolled in 10 centers in the United States and Europe. All patients underwent exercise and rest myocardial perfusion imaging with 99mTc-tetrofosmin using two separate injections of the radiotracer 4 hours apart on the same day. Planar images were obtained in three standard views 15 to 60 minutes after radiotracer injection. Patients also underwent standard exercise and redistribution planar 201Tl imaging within 2 weeks of tetrofosmin imaging. In addition, 58 healthy subjects with low likelihood of coronary artery disease underwent exercise and rest tetrofosmin imaging. Coronary angiograms were available in 181 patients with suspected coronary artery disease. All radionuclide images were processed in the central core laboratory and interpreted blindly by a panel of four experienced readers. 201Tl images and tetrofosmin images were read separately. Discrepancies were resolved by consensus. The workload, peak heart rate, and double products were comparable during exercise for both imaging agents. Technically acceptable paired 201Tl and tetrofosmin images were available in 224 of 252 patients. Tetrofosmin images were generally of good quality, with low extracardiac activity, and easy to interpret. Patients were categorized as showing normal, ischemia, infarction, or mixture with each imaging modality. Precise concordance for each of these categories was 59.4% (κ=0.44; 95% CI, 0.35 to 0.53). When patients were categorized as normal or abnormal, the concordance was 80.4% (κ=0.55; 95% CI, 0.43 to 0.67). When each of five anatomic territories (septal, anterior, inferior, lateral, and apical) was categorized as normal versus abnormal, the concordance varied from 81% to 90%. When similar comparison was made for the specific category of abnormality, the concordance was 64% to 84%. When coronary angiography was used as the criterion, the sensitivity and positive and negative predictive accuracy of tetrofosmin and 201Tl were comparable. The normalcy rate of tetrofosmin images in the healthy subjects with low likelihood of coronary artery disease was 97%. Conclusions: 99mTc tetrofosmin is a new myocardial imaging agent with favorable imaging characteristics with results comparable to those of 201Tl.

Original languageEnglish
Pages (from-to)313-319
Number of pages7
JournalCirculation
Volume91
Issue number2
StatePublished - Jan 15 1995
Externally publishedYes

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Myocardial Perfusion Imaging
Coronary Angiography
Multicenter Studies
Coronary Artery Disease
Exercise
Healthy Volunteers
Injections
technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane
Workload
Radioisotopes
Infarction
Angiography
Ischemia
Perfusion
Heart Rate
Sensitivity and Specificity

Keywords

  • Imaging
  • Tetrofosmin

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Zaret, B. L., Rigo, P., Wackers, F. J. T., Hendel, R., Braat, S. H., Iskandrian, A. S., ... Lahiri, A. (1995). Myocardial perfusion imaging with 99mTc tetrofosmin: Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial. Circulation, 91(2), 313-319.

Myocardial perfusion imaging with 99mTc tetrofosmin : Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial. / Zaret, Barry L.; Rigo, Pierre; Wackers, Frans J T; Hendel, Robert; Braat, Simon H.; Iskandrian, Ami S.; Sridhara, Bangalore S.; Jain, Diwakar; Itti, Roland; Serafini, Aldo N; Goris, Michael L.; Lahiri, Avijit.

In: Circulation, Vol. 91, No. 2, 15.01.1995, p. 313-319.

Research output: Contribution to journalArticle

Zaret, BL, Rigo, P, Wackers, FJT, Hendel, R, Braat, SH, Iskandrian, AS, Sridhara, BS, Jain, D, Itti, R, Serafini, AN, Goris, ML & Lahiri, A 1995, 'Myocardial perfusion imaging with 99mTc tetrofosmin: Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial', Circulation, vol. 91, no. 2, pp. 313-319.
Zaret BL, Rigo P, Wackers FJT, Hendel R, Braat SH, Iskandrian AS et al. Myocardial perfusion imaging with 99mTc tetrofosmin: Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial. Circulation. 1995 Jan 15;91(2):313-319.
Zaret, Barry L. ; Rigo, Pierre ; Wackers, Frans J T ; Hendel, Robert ; Braat, Simon H. ; Iskandrian, Ami S. ; Sridhara, Bangalore S. ; Jain, Diwakar ; Itti, Roland ; Serafini, Aldo N ; Goris, Michael L. ; Lahiri, Avijit. / Myocardial perfusion imaging with 99mTc tetrofosmin : Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial. In: Circulation. 1995 ; Vol. 91, No. 2. pp. 313-319.
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abstract = "Background: Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies. Methods and Results: Two hundred fifty-two patients with suspected coronary artery disease were enrolled in 10 centers in the United States and Europe. All patients underwent exercise and rest myocardial perfusion imaging with 99mTc-tetrofosmin using two separate injections of the radiotracer 4 hours apart on the same day. Planar images were obtained in three standard views 15 to 60 minutes after radiotracer injection. Patients also underwent standard exercise and redistribution planar 201Tl imaging within 2 weeks of tetrofosmin imaging. In addition, 58 healthy subjects with low likelihood of coronary artery disease underwent exercise and rest tetrofosmin imaging. Coronary angiograms were available in 181 patients with suspected coronary artery disease. All radionuclide images were processed in the central core laboratory and interpreted blindly by a panel of four experienced readers. 201Tl images and tetrofosmin images were read separately. Discrepancies were resolved by consensus. The workload, peak heart rate, and double products were comparable during exercise for both imaging agents. Technically acceptable paired 201Tl and tetrofosmin images were available in 224 of 252 patients. Tetrofosmin images were generally of good quality, with low extracardiac activity, and easy to interpret. Patients were categorized as showing normal, ischemia, infarction, or mixture with each imaging modality. Precise concordance for each of these categories was 59.4{\%} (κ=0.44; 95{\%} CI, 0.35 to 0.53). When patients were categorized as normal or abnormal, the concordance was 80.4{\%} (κ=0.55; 95{\%} CI, 0.43 to 0.67). When each of five anatomic territories (septal, anterior, inferior, lateral, and apical) was categorized as normal versus abnormal, the concordance varied from 81{\%} to 90{\%}. When similar comparison was made for the specific category of abnormality, the concordance was 64{\%} to 84{\%}. When coronary angiography was used as the criterion, the sensitivity and positive and negative predictive accuracy of tetrofosmin and 201Tl were comparable. The normalcy rate of tetrofosmin images in the healthy subjects with low likelihood of coronary artery disease was 97{\%}. Conclusions: 99mTc tetrofosmin is a new myocardial imaging agent with favorable imaging characteristics with results comparable to those of 201Tl.",
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T1 - Myocardial perfusion imaging with 99mTc tetrofosmin

T2 - Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial

AU - Zaret, Barry L.

AU - Rigo, Pierre

AU - Wackers, Frans J T

AU - Hendel, Robert

AU - Braat, Simon H.

AU - Iskandrian, Ami S.

AU - Sridhara, Bangalore S.

AU - Jain, Diwakar

AU - Itti, Roland

AU - Serafini, Aldo N

AU - Goris, Michael L.

AU - Lahiri, Avijit

PY - 1995/1/15

Y1 - 1995/1/15

N2 - Background: Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies. Methods and Results: Two hundred fifty-two patients with suspected coronary artery disease were enrolled in 10 centers in the United States and Europe. All patients underwent exercise and rest myocardial perfusion imaging with 99mTc-tetrofosmin using two separate injections of the radiotracer 4 hours apart on the same day. Planar images were obtained in three standard views 15 to 60 minutes after radiotracer injection. Patients also underwent standard exercise and redistribution planar 201Tl imaging within 2 weeks of tetrofosmin imaging. In addition, 58 healthy subjects with low likelihood of coronary artery disease underwent exercise and rest tetrofosmin imaging. Coronary angiograms were available in 181 patients with suspected coronary artery disease. All radionuclide images were processed in the central core laboratory and interpreted blindly by a panel of four experienced readers. 201Tl images and tetrofosmin images were read separately. Discrepancies were resolved by consensus. The workload, peak heart rate, and double products were comparable during exercise for both imaging agents. Technically acceptable paired 201Tl and tetrofosmin images were available in 224 of 252 patients. Tetrofosmin images were generally of good quality, with low extracardiac activity, and easy to interpret. Patients were categorized as showing normal, ischemia, infarction, or mixture with each imaging modality. Precise concordance for each of these categories was 59.4% (κ=0.44; 95% CI, 0.35 to 0.53). When patients were categorized as normal or abnormal, the concordance was 80.4% (κ=0.55; 95% CI, 0.43 to 0.67). When each of five anatomic territories (septal, anterior, inferior, lateral, and apical) was categorized as normal versus abnormal, the concordance varied from 81% to 90%. When similar comparison was made for the specific category of abnormality, the concordance was 64% to 84%. When coronary angiography was used as the criterion, the sensitivity and positive and negative predictive accuracy of tetrofosmin and 201Tl were comparable. The normalcy rate of tetrofosmin images in the healthy subjects with low likelihood of coronary artery disease was 97%. Conclusions: 99mTc tetrofosmin is a new myocardial imaging agent with favorable imaging characteristics with results comparable to those of 201Tl.

AB - Background: Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies. Methods and Results: Two hundred fifty-two patients with suspected coronary artery disease were enrolled in 10 centers in the United States and Europe. All patients underwent exercise and rest myocardial perfusion imaging with 99mTc-tetrofosmin using two separate injections of the radiotracer 4 hours apart on the same day. Planar images were obtained in three standard views 15 to 60 minutes after radiotracer injection. Patients also underwent standard exercise and redistribution planar 201Tl imaging within 2 weeks of tetrofosmin imaging. In addition, 58 healthy subjects with low likelihood of coronary artery disease underwent exercise and rest tetrofosmin imaging. Coronary angiograms were available in 181 patients with suspected coronary artery disease. All radionuclide images were processed in the central core laboratory and interpreted blindly by a panel of four experienced readers. 201Tl images and tetrofosmin images were read separately. Discrepancies were resolved by consensus. The workload, peak heart rate, and double products were comparable during exercise for both imaging agents. Technically acceptable paired 201Tl and tetrofosmin images were available in 224 of 252 patients. Tetrofosmin images were generally of good quality, with low extracardiac activity, and easy to interpret. Patients were categorized as showing normal, ischemia, infarction, or mixture with each imaging modality. Precise concordance for each of these categories was 59.4% (κ=0.44; 95% CI, 0.35 to 0.53). When patients were categorized as normal or abnormal, the concordance was 80.4% (κ=0.55; 95% CI, 0.43 to 0.67). When each of five anatomic territories (septal, anterior, inferior, lateral, and apical) was categorized as normal versus abnormal, the concordance varied from 81% to 90%. When similar comparison was made for the specific category of abnormality, the concordance was 64% to 84%. When coronary angiography was used as the criterion, the sensitivity and positive and negative predictive accuracy of tetrofosmin and 201Tl were comparable. The normalcy rate of tetrofosmin images in the healthy subjects with low likelihood of coronary artery disease was 97%. Conclusions: 99mTc tetrofosmin is a new myocardial imaging agent with favorable imaging characteristics with results comparable to those of 201Tl.

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