99mTc-MIBI Washout Rate to Evaluate the Effects of Steroid Therapy in Cardiac Sarcoidosis

Document Type : Original Article

Authors

1 Department of Cardiology, Fujita Health University School of Medicine, Japan

2 Department of Radiology, Fujita Health University School of Medicine, Japan

Abstract

Objective(s): We sought to determine the usefulness of the 99mTc-MIBI (MIBI) washout rate for the evaluation of steroid therapy in cardiac sarcoidosis (CS).
Methods: Eleven CS patients underwent MIBI myocardial SPECT both before and 6 months after initiating steroid therapy. The washout rate (WOR) of MIBI was calculated using early and delayed polar map images. The washout score (WOS) of MIBI was derived from the difference between the early and delayed total defect scores (TDS).
Results: Serum ACE and BNP exhibited significant improvement after the therapy (p = 0.004, p = 0.045). In the LV function, EDV and E/A ratio exhibited significant improvement after the therapy (p = 0.041, p = 0.007), while there were no significant differences between before and after therapy in EF or ESV. Early and delayed TDS showed no significant differences between before and after the therapy. In contrast, WOR differed significantly (p < .0001), while WOS did not differ significantly between before and after the therapy.
Conclusion: The washout rate of MIBI is suitable for assessment of cardiac function in CS with steroid therapy, being especially better than the washout score of MIBI for assessment of disease activity of mild myocardial damage in CS with steroid therapy.

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References

  1. Schaumann J. Lymphogranulomatosis benign in light of prolonged clinical observations and autopsy findings. Br J Dermatol 1936;48:399-446.
  2. Matsui Y, Iwai K, Tachibana T, Fruie T, Shigematsu N, Izumi T, et al. Clinicopathological study on fatal myocardial sarcoidosis. Ann NY Acad Sci 1976;278:455-69.
  3. Uemura A, Morimoto S, Hiramitsu S, Kato Y, Ito T, Hishida H, et al. Histological diagnostic rate of cardiac sarcoidosis: Evaluation of endomyocardial biopsies. Am Heart J 1999;138:299-302.
  4. Soejima K, Yada H. The work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities. J Cardiovasc Electrophysiol 2009;20:578-83.
  5. Takeishi Y, Sukekawa H, Fujiwara S, Ikeno E, Sasaki Y, Tomoike H, et al. Reverse redistribution of technetium-99m-sestamibi following direct PTCA in acute myocardial infarction. J Nucl Med 1996;37:1289–94.
  6. Kumita S, Seino Y, Cho K, Nakajo H, Toba M, Fukushima Y, et al. Assessment of myocardial washout of Tc-99m-sestamibi in patients with chronic heart failure: Comparison with normal control. Ann Nucl Med 2002;16:237-42.
  7. Sugiura T, Takase H, Toriyama T, Goto T, Ueda R, Dohi Y. Usefulness of Tc-99m methoxyisobutylisonitrile scintigraphy for evaluating congestive heart failure. J Nucl Cardiol 2006;13:64-8.
  8. Matuo S, Nakae I, Tsutamoto T, Okamoto N, Horie M. A novel clinical indicator using Tc-99m sestamibi for evaluating cardiac mitochondrial function in patients with cardiomyopathies. J Nucl Cardiol 2007;14:215-20.
  9. Yazaki Y, Isobe M, Hiroe M, Morimoto S, Hiramitsu S, Nakano T, et al. Prognostic Determinant of Long-Term Survival in Japanese Patients With Cardiac Sarcoidosis Treated With Prednisone. Am J Cardiol 2001;88:1006-10.
  10. Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J 2005;26:1538-43.
  11. Okumura W, Iwasaki T, Toyama T, Iso T, Arai M, Oriuchi N. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med 2004;45:1989-98.
  12. Kudoh H, Fujiwara S, Shiotani H, Kawai H, Hirata K. Myocardial washout of 99mTc-tetrofosmin and response to steroid therapy in patients with cardiac sarcoidosis. Ann Nucl Med 2010;24:379-85.
  13. Piwnica-Worms D, Kronauge JF, Chiu ML. Uptake and retention of hexakis (2-methoxyisobutyl isonitrile technetium (I) in cultured chick myocardial cells. Mitochondrial and plasma membrane potential dependence. Circulation 1990;82:1826-38.
  14. Beanlands RS, Dawood F, Wen WH, McLaughlin PR, Butany J, D’Amati G, et al. Are the kinetics of technetium-99m methoxyisobutyl isonitrile affected by cell metabolism and viability? Circulation 1990;82:1802-14.
  15. Fahy GJ, Marwick T, McCeery CJ, Quigley PJ, Maurer BJ. Doppler echocardiographic detection of left ventricular diastolic dysfunction in patients with pulmonary sarcoidosis. Chest 1996;109:62-6.
  16. Isobe S, Ohshima S, Unno K, Izawa H, Kato K, Noda A, et al. Relation of 99mTc-sestamibi washout with myocardial properties in patients with hypertrophic cardiomyopathy. J Nucl Cardiol 2010;17:1082-90.
  17. Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y, et al. B-Type Natriuretic Peptide Strongly Reflects Diastolic Wall Stress in Patients With Chronic Heart Failure: Comparison Between Systolic and Diastolic Heart Failure. J Am Coll Cardiol 2006; 47:742-8.

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