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Effects of Perfusion Defect on the Measurement of Left Ventricular Mass, Ventricular Volume and Post-stress Left Ventricular Ejection Fraction in Gated Myocardial Perfusion SPECT  

Ahn, Byeong-Cheol (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Bae, Sun-Keun (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Lee, Sang-Woo (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Jeong, Sin-Young (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Lee, Jae-Tae (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Lee, Kyu-Bo (Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University Medical School)
Publication Information
The Korean Journal of Nuclear Medicine / v.36, no.6, 2002 , pp. 381-391 More about this Journal
Abstract
Purpose: The presence of perfusion defect may influence the left ventricular mass (LVM) measurement by quantitative gated myocardial perfusion SPECT (QGS), and ischemic myocardium, usually showing perfusion defect may produce post-stress LV dysfunction. This study was aimed to evaluate the effects of extent and reversibility of perfusion defect on the automatic measurement of LVM by QGS and to investigate the effect of reversibility of perfusion defect on post-stress LV dysfunction. Subjects and Methods: Forty-six patients (male/female=34:12, mean age=64years) with perfusion defect on myocardial perfusion SPECT underwent rest and post-stress QGS. Forty patients (87%) showed reversible defect. End-diastolic volume (EDV), end-systolic volume (ESV), LV ejection fraction (EF), and LV myocardial volume were obtained from QGS by AutoQUANT program, and LVM was calculated by multiplying the LV myocardial volume by the specific gravity of myocardium. Results: LVMs measured at rest and post-stress QGS showed good correlation, and higher correlation was founded in the subjects with fixed perfusion defect and with small defect (smaller than 20%). There were no significant differences in EDVs, ESVs and EFs between obtained by rest and post-stress QGS un patients with fixed myocardial defect. Whereas, EF obtained by post-stress QGS was lower than that by rest QGS in patients with reversible defect and 10 (25%) of them showed decreases in EF more than 5% in post-stress QGS, as compared to that of rest QGS. Excellent correlations of EDVs, ESVs, EFs between rest and post-stress QGS were noted. Patients with fixed defect had higher correlation between EDVs, ESVs, EFs than patients with reversible defect. Conclusion: These results suggest that perfusion defect can affect LVM measurement by QGS and patients with reversible defect shows post-stress LV dysfunction more frequently than patients with fixed perfusion defect.
Keywords
Perfusion defect; Gated myocardial perfusion SPECT; Left ventricular mass; Myocardial stunning; Ejection fraction;
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1 Germano G, Erel J, Lewin H, Kavannagh PB,Berman DS. Automatic quantitation of regionalmyocardial wall motion and thickening fromgated technetium-99m sestamibi myocardialperfusion single-photon emission computedtomography. J Am Coli Cardiol 1997;30:1360-7.
2 Verdecchia P, Schillaci G, Borgioni C, CiucciA, Gattobigio R, Zampi I, et al. Prognosticsignificance of serial changes in left ventricularmass in essential hypertension. Circulation 1998;97:48-54.
3 Scognamiglio R, Ponchia A, Fasoli G, Miraglia G, Dalla Volta S. Exercise-induced left ventriculardysfunction in coronary heart disease. Amodel for studying the stunned myocardium inman. Eur Heart J 1991;12:16-9.
4 Lee DS, Yeo JS, Chung JK, Lee MM, Lee Me.Transient prolonged stunning induced by dipyridamoleand shown in 1 and 24 hour post-stressTc-99m sestamibi gated SPECT. J Nucl Med2000;41:27-35.
5 Kloner RA, Bolli R, Marban E, Reinlib L,Braunwald E. Medical and cellular implicationsof stunning, hibernation, and preconditioning: AnNHLBI workshop. Circulation 1998;97:1848-67.
6 Acampa W, Cuocolo A, Sullo P, Varrone A,Nicolai E, Pace L, et al. Direct comparison oftechnetium 99m-tetrofosmin cardiac single photonemission computed tomography in patients withcoronary artery disease. J Nucl Cardiol 1998;5:265-74.
7 Bavelaar-Croon CL, Pauwels EK, van der Wall EE. Gated single-photon emission computed tomographic myocardial imaging: A new tool in clinical cardiology. Am Heart J 2001;141:383- 90.
8 Nixon IV, Brown CN, Smitherman TC. Identificationof transient and persistent segmentalwall motion abnormalities in patients withunstable angina by two-dimensional echocardiogrpahy.Circulation 1982;65:1497-503.
9 Vallejo E, Dione DP, Bruni WL, Todd ConstableR, Borek PP, Soares JP, et al.Reproducibility and accuracy of gated SPECTfor determination of left ventricular volumes andejection fraction: Experimental validation usingMR!. J Nucl Med 2000;41:874-82.
10 Bolli R. Myocardial 'stunning' in man. Circulation1992;86:1671-91.
11 Kloner RA, Allen J, Cox TA, Zheng Y, RuizCEo Stunned left ventricular myocardium afterexercise treadmill testing in coronary arterydisease. Am J Cardiol 1991;68:329-34.
12 Park YR, Ran JY, Ahn BC, Park RS, Cho YK,Lee J, et al. Post -stress measurements of leftventricular function with gated perfusion SPECT:comparison with resting measurement by usingexercise and adenosine stress. Kor Circulat J2001;31:1019-26.
13 Germano G, Kavanagh PB, Waechter P, AreedaJ, Van Kriekinge S, Sharir T, et al. A newalgorithm for the quantitation of myocardialperfusion SPECT. I: technical principles andreproducibility. J Nucl Med 2000;41:712-9.
14 Bestetti A, DiLeo C, Alessi A, Triulzi A,Tagliabue L, Tarolo GL. Post-stress end-systolicleft ventricular dilation: a marker of endocardialpost-ischemic stunning. Nucl Med Comm 2001;22:685-93.
15 Hashimoto I, Kubo A, Iwasaki R, Iwanaga S,Mitamura H, Ogawa S, et al. Gated singlephotonemission tomography imaging protocol toevaluate myocardial stunning after exercise. EurJ Nucl Med 1999;26:1541-6.
16 Bolli R. Why myocardial stunning is clinicallyimportant. Basic Res Cardiol 1998;93:169-72.
17 Santiago JY, Heiba SI, Jana S, Mirzaitehrane M,Dede F, Abdel-Dayem HM. Transient ischemicstunning of the myocardium in stress thallium-201 gated SPET myocardial perfusion imaging:segmental analysis of myocardial perfusion, wallmotion and wall thickening changes. Eur J NuclMed 2002;29:979-83.
18 Carine DB, Yves GA, Douwe EA, Petra DS,Aelco HZ, Marcel PS, et al. Comparison of left ventricular function at rest and post -stress inpatients with myocardial infarction: Evaluationwith gated SPECT. J Nucl Cardiol 2001;8:10-8.
19 Johnson LL, Verdesca SA, Aude WY, XavierRC, Nott LT, Campanella MW, et al. Postischemicstunning can affect left ventricularejection fraction and regional wall motion onpost-stress gated sestamibi tomograms. J AmColi Cardiol 1997;30:1641-8.
20 Konno M, Morita K, Adachi I, Ito Y, Kohya T,Kitabatake A, et al. Quantitative analysis ofregional wall motion and thickening by quantitativegated SPECT. Comparison with visualanalysis. Clin Nucl Med 2001;26:202-7.
21 Williams KA, Lang RM, Reba RC, Tallion LA.Comparison of technetium-99m sestamibi-gatedtomographic perfusion imaging with echocardiographicand electrocardiography for determinationof left ventricular mass. Am J Cardial1996;77:750-5.
22 Bavelaar-Croon CL, Atsma DE, van der WallEE, Diffets-Schneider P, Zwinderman AH,Pauwels EK. The additive value of gated SPETmyocardial perfusion imagings in patients withknown and suspected coronary artery disease.Nucl Med Comm 2001;22:45-55.
23 Germano G, Kiat H, Kavannagh PB, Moriel M,Massanti M, Su HT, et al. Automatic quantificationof ejection fraction from gated myocardialperfusion SPECT. J Nucl Med 1995;36:2138-47.
24 Germano G, Berman DS. On the accuracy andreproducibility of quantitative gated myocardialperfusion SPECT. J Nucl Med 1999;40:810-3.
25 Braunwald E, Kloner RA. The stunned myocardium:prolonged post ischemic ventriculardysfunction. Circulation 1982;66:1146-9.
26 Rozanski A, Berman D, Gray R, Diamond G,Raymond M, Prause J, et al. Preoperativeprediction of reversible myocardial asynergy by postexercise radionuclide ventriculography. NEng J Med 1982;307:212-6.
27 Carluccio E, Tommasi S, Bentivoglio M,Buccolieri M, Filippucci L, Prosciutti L, et al.Prognostic value of ventricular hypertrophy andgeometry in patients with a first, uncomplicatedmyocardial infarction. Int J Cardiol 2000;74:177-83.
28 Thorley PI, Ball J, Sheard KL, SilvananthanUM. Evaluation of Tc-99m-tetrofosmin as amyocardial perfusion agent in routine clinicaluse. Nucl Med Comm 1995;16:733-40.
29 Naqvi TZ, Goel RK, Forrester JS, David.';onRM, Siegel RJ. Usefulness of left ventricularmass in predicting recovery of left ventricularsystolic function in patients with symptomaticidiopathic dilated cardiomyopathy. Am J Cardiol2000;85:624-9.
30 Paul AK, Hasegawa S, Yoshioka J, TsujimuraE, Yamaguchi H, Tokita N, et al. Exerciseinducedstuuning continues for at least one hour:Evaluation with quantitative gated single photon emission tomography. Eur J Nucl Med 1999;26:410-5.
31 Hyun IY, Kwan J, Park KS, Lee WH. Reproducibilityof TI-201 and Tc-99m sestamibi gatedmyocardial perfusion SPECT measurement ofmyocardial function. J Nucl Cardial 2001;8:182-7.
32 Germano G, Kavannagh PB, Berman DS. Anautomatic approach to the analysis, quantitationand review of perfusion and function frommyocardial perfusion SPECT images. Int J CardImaging 1997;13:337-46.
33 Ambrosio G, Betocchi S, Pace L, Losi MA,Perrone-Filardi P, Soricelli A, et al. Prolongedimpairment of regional contractile function afterresolution of exercise-induced angina. Evidenceof myocardial stunning in patients with coronaryartery disease. Circulation 1996;94:2455-64.
34 Iskandrian AE, Germano G, VanDecker W,Ogilby JD, Wolf N, Mintz R, et al. Validationof left ventricular volume measurements bygated SPECT $^{99m}$Tc-Iabeled sestamibi imaging. JNucl Cardia I 1998;5:574-8.