Efforts to visually match 5- and 60-minute post-stress images following a single injected dose of sestamibi clearly demonstrate changes in sestamibi distribution: Demonstrating once and for all clinical recognition that sestamibi redistributes

Abstract

Importance: Sestamibi imaging has been available for approximately three decades. During that time there has been considerable evidence published in the medical literature demonstrating that Sestamibi redistributes. Despite these publications, Lantheus has continued to insist that Sestamibi does not redistribute and that two doses of radioactive isotope are needed to conduct myocardial perfusion imaging. Isotope package inserts have maintained that Sestamibi is initially taken up by the heart within minutes without redistribution making it not only possible but acceptable to wait until 60-minutes to begin imaging. This approach then requires a second dose of Sestamibi to acquire comparative images for clinical decision-making according to the Sestamibi package insert.

Objective: This study not only considers those publications validating Sestamibi redistribution, but looked at whether experienced professionals were able to match 10-patients initial 5-minute images with sequential 60-minute images, which would be identical if in fact there was no Sestamibi redistribution.

Design: Nineteen trained and certified nuclear medicine professionals were provided with two sets of images from 10-different patients, each of whom had different areas of ischemia on their myocardial perfusion imaging studies, making every patient different from the others. Professionals were then asked to match initial and sequential images of these 10-patients, basing their matching of images purely upon the premise that Sestamibi does NOT redistribute making the initial and sequential images identical.

Setting: The images were presented at a Nuclear Medicine Conference, where professionals were receiving continuing medical education and credit. Participants were volunteers. Images were projected onto conference Screens and participants were allowed to examine the studies from any position in the conference hall.

Results: Of the 19 participants, only one matched three of the patients, with one of these being the patient with a dilated cardiomyopathy. Five matched two of the patients while 31.6% matched only one patient and 36.8% matched none of the patients. When the patient with a dilated cardiomyopathy was removed from the data set, there were only 15 of 180 correct matches.

Conclusions: The failure of these professionals to match the two sets of images demonstrates that the sequential images are different from the initial images and that SESTAMIBI DOES IN FACT REDISTRIBUTE. By failing to image at 5-minutes post-stress and sequentially imaging at 60-minutes, there is a failure to find up to 40% of actionable ischemic heart disease.