The use of GTN to improve the detection of ischaemic myocardium using 99Tcm-tetrofosmin

Recent work has shown that rest 99Tcm-sestamibi uptake may underestimate the amount of perfused myocardium, suggesting infarct tissue in some instances when myocardium is hypoperfused but which will benefit from revascularization. Administration of nitrates before a resting 99Tcm-sestamibi injection has been shown to increase tracer uptake. We have used 99Tcm-tetrofosmin as a myocardial perfusion agent and imaged 30 patients at stress, rest and again at rest following administration of sublingual nitrates. All patients had angiographically demonstrated severe coronary artery disease and 27 patients had previous infarction. Twenty-one patients were stressed on a treadmill and nine using intravenous dobutamine. Images were analysed using both a visual and semi-quantitative analysis. Defects were observed in 39 coronary artery territories on stress 99Tcm-tetrofosmin imaging, 23 appearing fixed on standard rest imaging. Twelve (52%) of these defects showed reversibility on rest with glyceryl trinitrate (GTN) imaging and increased reversibility was seen in 62% of defects reversible at rest. We conclude that, in patients with severe coronary artery disease and fixed rest defects, GTN given prior to the rest injection appears to improve the detection of ischaemic hypoperfused myocardium.