The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Dipyridamole Induced Transient Left Ventricular Dysfunction in the Tl-201 Gated Myocardial SPECT

Tl-201 게이트 심근 SPECT에서 디피리다몰 부하로 유도된 일시적 좌심실 기능이상

  • Won, Kyoung-Sook (Department of Nuclear Medicine, Keimyung University School of Medicine)
  • 원경숙 (계명대학교 의과대학 핵의학교실)
  • Published : 2003.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Recently the occurrence of dipyridamole stress-induced short term stunning was proven and it is reported that Bland Altman analysis by repeated acquisition Tl-201 gated myocardial SPECT (gSPECT) revealed the 95% limit of agreement for LVEF was 10.3 %. The purpose of this study was to investigate the clinical value of dipyridamole induced transient LV dysfunction on Tl-201 gSPECT. Materials and Methods: Total 93 patients were included and coronary angiography was peformed in all patients less than 2 month from gSPECT. The patients with myocardial infarction were excluded. All patients underwent both dipyridamole stress and 4-h redistribution Tl-201 gSPECT. Forty nine patients of total 93 showed normal coronary arteries (Group 1) and the remaining 44 patients had coronary artery disease (Group 2). We compared LV EF, EDV and ESV during post-stress and 4-h redistribution period calculated by gSPECT using quantitative gated SPECT software and the incidence of dipyridamole induced transient LV dysfunction between group 1 and 2. The criteria for transient LV dysfunction was defined more decrease ${\geq}11%$ of LVEF during post-stress than 4-h redistribution according to previous reported Bland Altman analysis. Results: During post-stress and 4-h redistribution average of 3.1% increment in LVEF, 6.6% increment in LVEDV and 0.7% decrement in LVESV were shown after stress in Group 1, whereas 4.1% decrement, 9.7% increment and 7.2% increment in Group 2 respectively. Dipyridamole induced transient LV dysfunction was only detected in group 2 (18.2%) and not in group 1. It was more frequently observed in triple vessel disease and left main disease (31.8%, N=22) than one and two vessel disease (4.5%, N=22). Conclusion: As with Tc-99m myocardial agent post-stress LV dysfunction was observed in dipyridamole Tl-201 gSPECT. It was only detected in CAD and more frequently occurred in multivessel disease. Thus this finding seems to provide additional information in the diagnosis of coronary artery disease and prediction of prognosis.

목적: 이 연구의 목적은 Tl-201 게이트 심근 SPECT시 나타나는 부하 후 일시적 좌심실 기능이상의 임상적 의미를 알아보고자 하는 것이다. 대상 및 방법: 연구대상은 디피리다몰 부하 게이트 심근 SPECT를 시행한 환자 중 관상동맥조영술을 두 달 이내에 시행한 환자로 이 중 심근경색이 있는 경우는 제외하였다. 게이트 SPECT는 부하기와 재분포기 모두 실시하였으며 부하시 좌심실 구혈률이 재 분포기에 비하여 11%이상 감소한 경우에 부하 후 심근 기절이 있다고 정의하였다. 총 93명의 대상환자를 관상동맥조영술 결과에 따라 정상(1군)과 관상동맥 질환(2군)의 두 군으로 나누어 부하 후 좌심실 기능이상의 빈도에 차이가 있는지 알아보았다. 결과: 정상 대조군에서 좌심실 구혈률은 4시간 재분포기에 비하여 부하기에 평균 3.1% 증가하였으나, 관상동맥질환군에서는 평균 4.1% 감소하였다(p<0.01). 이완기말 좌심실 용적은 두 군 모두 부하기에 증가를 보였으며, 두 군 간에 유의한 차이가 없었다. 수축기말 좌심실 용적은 정상 대조군에서는 부하기에 0.7% 감소하였으나, 관상동맥질환군에서는 7.2% 증가하였다(p<0.01). 부하 후 좌심실 기능 이상은 1군 62명 중 0명, 2군 44명 중 8명(18.2%)으로 2군에서 유의하게 많았다(p<0.01). 정상 대조군에서 부하 후 일시적 좌심실 기능이상은 한 예도 관찰되지 않았다. 44명의 관상동맥질환 환자 중 8명에서 일시적 좌심실 기능이상이 관찰되었는데 단일혈관 협착에서 1 예(9.1%), 2 혈관 협착에서 0(0%), 3혈관 협착에서 2 예(14.3%), 좌주간동맥협착에서 5 예(62.5%)였다. 관상동맥질환 환자군을 다시 단일과 두 혈관 협착군과 세 혈관협착과 좌주간동맥 협착군의 두 군으로 나누어 일시적 좌심실기능이상의 빈도를 비교하였을 때 4.5%와 31.8%로 유의한 차이를 보였다(p<0.05). 결론: 디피리다몰과 Tl-201을 이용한 게이트 심근 SPECT에서 심근경색을 제외한 관상동맥질환이 있는 경우 약 20%에서 부하 후 심근기절이 나타남을 알 수 있었으며, 하나 또는 두 혈관질환보다는 세 혈관 질환 또는 좌주간지 협착에서 더 많이 발생하는 경향이 있어 관상동맥질환의 중증도 계층화와 예후추정에 대한 부가적인 정보를 제공할 수 있을 것으로 보인다.

Keywords

References

  1. Wackers FJTh, Maniawski P, Sinusas AJ. Evaluation of left ventricular wall function by ECG-gated Tc-99m-sestamibi imaging. In: Beller GA, Zaret BL, eds. Nuclear Cardiology: state of the art and future direction. St. Louis: Mosby, 1993:85-100
  2. Chua T, Yin LC, Thiang TH, Chao TB. Ping DZ. Leng LY. Accuracy of the automated assessment of left ventricular function with gated perfusion SPECT in the presence of perfusion defects and left ventricular dysfunction: correlation with equilibrium radionuclide ventriculography and echocardiography. J Nucl Cardiol 2000;7:301-11
  3. Taillefer R, DePuey EG, Udelson JE, Beller GA. Benjamin C. Gagnon A. Comparison between the end-diastolic images and the summed images of gated Tc-99m-sestamibi SPECT perfusion study in detection of coronary artery disease in women. J Nucl Cardiol 1999;6:169-76
  4. Beller GA, Zaret BL. Contribution of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 2000; 101:1465-78
  5. Leoncini M. Sciagra R. Maioli M. Bellandi F. Marcucci G. Sestini S. et al. Usefulness of dobutamine Tc-99m sestamibi-gated single-photon emission computed tomography for prediction of left ventricular ejection fraction outcome after coronary revascularization for ischeruic cardiomyopathy. Am J Cardiol 2002;89:817-21
  6. Germano G, Erel J, Kiat H, Kavanagh PB, Berman D. Quantitative left ventricular ejection fraction and qualitative regional function from gated Tl-201 perfusion SPECT. J Nucl med 1997;38:749-54
  7. Manoury C, Chen CC, Chua KB, Thompson CJ. Quantification of left ventricular function with Tl-201 and Tc-99m sestamibi myocardial gated SPECT. J Nucl Med 1997;38:958-61
  8. He ZX, Cwaje E, Preslar JS, Mahmarian JJ, Verani MS. Accuracy of LYEF determined by gatedmyocardial perfusion SPECT with Tl-201 and Tc-99m sestamibi:comparison with frrst pass radionuclide angiography. J Nucl Cardiol 1999:6:412-17
  9. Berman D, Kiat H, Friedman J, Wang FP, van Train K, Matzer L, et al. Separate acquisition rest Tl-201/stress Tc-99m sestamibi dual isotope myocardial perfusion SPECT: a clinical validation study. J Am Coli Cardiol 1993; 22:1455-64
  10. Nichols K, Lefkowitz D, Faber T, Folks R, Cooke D, Garcia EV, et al. Echocardiographic validation of gated SPECT ventricle function measurements. J Nucl Med 2000; 41:1308-14
  11. Heyndrickx GR, millard RW, McRitchie RJ, Marko PR, Vatner SF. Regional myocardial function and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest 1975; 56:978-85
  12. Thaulow E, Guth BD, Heusch G, Gilpin E. Schulz R. Kroeger K, et al. Characteristics of regional myocardial stunning after exercise in dogs with chronic coronary stenosis. Am J Physiol 1989;257:113-9
  13. Brawnwald E, Kloner RA. The stunned myocardium: prolonged post ischemic ventricular dysfunction. Circulation 1982;66:1146-9
  14. Johnson LL, Verdesca SA, Aude WY, Xavier RC, Nott LT, Campanella MW, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997;30:1641-8
  15. Paul AK, Hasegawa S, Yoshioka J, Tsujimura E, Yamaguchi H, Tokita N, et al. Exercise-induced stunning continues for at least one hour: Evaluation with quantitative gated single photon emission tomography. Eur J Nucl Med 1999;26:410-5
  16. Hashimoto J, Kubo A, Iwasaki S, Iwanaga S, Mitamura H, Ogawa S, et al. Gated single photon emission tomography imaging protocol to evaluate myocardial stunning after exercise. Eur J Nucl Med 1999;26:1541-6
  17. Bestetti A, DiLeo C, Alessi A, Triulzi A, Tagliabue L, Tarolo GL. Post-stress end-systolic left ventricular dilatation: a marker of endocardial post-ischemic stunning. Nucl Med Comm 2001;22:685-93
  18. Lee DS, Yeo JS, Chung JK, Lee MM, Lee MC. Transient prolonged stunning induced by dipyridamole and shown 1 in and 24 hour post-stress Tc-99m sestamibi gated SPECT. J Nucl Med 2000;41:27-35
  19. Hyun IY, Kwan J, Park KS, Lee WH. Reproducibility of 11-201 and Tc-99m sestamibi gated myocardial SPECT measurement of myocardial function. J Nucl Cardiol 2001;8:182-7
  20. Picano E. Dipyridamole stress echocardiography. In: Picano E, ed. Stress Echocardiography. 3rd ed. Berlin, Germany:Springer; 1997:108-16
  21. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:1238-47
  22. Slutsky R, Karliner J, Ricci D, Schuler G, Pfisterer M, Peterson K, et al. Response of left ventricular volume to exercise in man assessed by radionuclide equilibrium angiography. Circulation 1997;60:565-71
  23. McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imging. J Nucl Cardiol 2002;9 ;663-7
  24. Iskandrian AS, Heo J, Nguyen T, Lyons E, Paugh E. Left ventricular dilatation and pu1monary thallium uptake after single-photon emission computer tomography using thallium-201 during adenosine-induced coronary hyperemia. Am J Cardiol 1990;66:807-11
  25. Takeishi Y, Tono-oka I, Ikeda K, Komatani A, Tsuiki K, Yasui S. Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging: a new marker of triple-vessel disease. Am Heart J 1991;121:466-75
  26. Marcassa C, Galli M, Baroffio C, Campini R, Giannuzzi P. Transient left ventricular dilation at quantitative stress-rest sestamibi tomography: clinical, electrocardiographic, and angiographic correlates. J Nucl Cardiol 1999;6:397-405
  27. Van Tosh A, Hecht S, Berger M, Roberti R, Luna E, Horowitz SF. Exercise echocardiographic correlates of transient dilatation of the left ventricular cavity on exercise thallium-201 SPECT imaging. Chest 1994;106:1725-9
  28. Bestetti A, Di Leo C, Alessi A, Triulzi A, Tagliabue L, Tarolo GL. Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning. Nucl Med Commun 2001;22:685-93
  29. Weiss AT, Berman DS, Lew AS, Nielsen J, Potkin B, Swan HI, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752-9
  30. Chouraqui P, Rodrigues EA, Berman DS, Maddahi J. Significance of dipyridamole-induced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected corouary artery disease. Am J Cardiol 1990;66:689-94
  31. Chua T, Kiat H, Germano G, Maurer G, van Train K, Friedman J, et al. Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion. postexercise regional ventricular function and myocardial viability: correlation with echocardiography and rest thallium-201 scintigraphy. J Am Coll Cardiol 1994;23:1107-14
  32. DePuey EG, Parmett S, Ghesani M, Rozanski A, Nichols K, Salensky H. Comparison of Tc-99m sestamibi and 11-201 gated perfusion SPECT. J Nucl Cardiol 1999; 6:278-85
  33. Heiba SI, Santiago J, Mirzaitehrane M, Jana S, Dede F, Abdel-Dayem HM. Transient postischemic stunning evaluation by stress gated T1-20l SPECT myocardial imaging: Effect on systolic left ventricular function, J Nucl Cardiol 2002;9:482-90
  34. Santiago JY, Heiba SI, Jana S, Mirzaitehrane M, Dede F, Abdel-Dayem HM. Transient ischemic stunning of the myocardium in stress thallium-20l gated SPET myocardial perfusion imaging: segmental analysis of myocardial perfusion, wall motion and wall thickening changes. Eur J Nucl Med 2002;29:979-83
  35. Manrique A, Faraggi M, Vera P, Vilain D, Lebtahi R, Cribier A, et al. 201T1 and 99mTc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: comparison with equilibrium radionuclide angiography. J Nucl Med 1999;40:805-9
  36. Shimotsu Y, Ishida Y, Murakawa K, Katafuchi T, Fukuchi K, Hayashida K, et al. Evaluation of the automatic quantification of left ventricular function using ECG gated 99mTc-MIBI myocardial SPECT. Kaku Igaku 1997;34:1093-9
  37. Gayed I, Cid E, Bocca1andero F, Podoloff D. Factors Affecting Left Ventricular Ejection Fraction Using Automated Quantitative Gated SPECT. Clin Nucl Med 2003;28:290-5