• The Korean Journal of Nuclear Medicine
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• v.37 no.2
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• pp.73-82
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• 2003

Objectives: A new software (Cardiac SPECT Analyzer: CSA) was developed for quantification of volumes and election fraction on gated myocardial SPECT. Volumes and ejection fraction by CSA were validated by comparing with those quantified by Quantitative Gated SPECT (QGS) software. Materials and Methods: Gated myocardial SPECT was peformed in 40 patients with ejection fraction from 15% to 85%. In 26 patients, gated myocardial SPECT was acquired again with the patients in situ. A cylinder model was used to eliminate noise semi-automatically and profile data was extracted using Gaussian fitting after smoothing. The boundary points of endo- and epicardium were found using an iterative learning algorithm. Enddiastolic (EDV) and endsystolic volumes (ESV) and election fraction (EF) were calculated. These values were compared with those calculated by QGS and the same gated SPECT data was repeatedly quantified by CSA and variation of the values on sequential measurements of the same patients on the repeated acquisition. Results: From the 40 patient data, EF, EDV and ESV by CSA were correlated with those by QGS with the correlation coefficients of 0.97, 0.92, 0.96. Two standard deviation (SD) of EF on Bland Altman plot was 10.1%. Repeated measurements of EF, EDV, and ESV by CSA were correlated with each other with the coefficients of 0.96, 0.99, and 0.99 for EF, EDV and ESV respectively. On repeated acquisition, reproducibility was also excellent with correlation coefficients of 0.89, 0.97, 0.98, and coefficient of variation of 8.2%, 5.4mL, 8.5mL and 2SD of 10.6%, 21.2mL, and 16.4mL on Bland Altman plot for EF, EDV and ESV. Conclusion: We developed the software of CSA for quantification of volumes and ejection fraction on gated myocardial SPECT. Volumes and ejection fraction quantified using this software was found valid for its correctness and precision.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.3-9
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• 2009

Purpose: It is well-known that stress-induced stunning and reversible perfusion defect have impact on ejection fraction (EF) when performing myocardial perfusion SPECT. Due to these reasons, gated SPECT is recommended at stress and rest studies. And there was many experiments to analyze between Stress and Rest EF by using $^{99m}Tc$-MIBI. The aim of this study is to analyze between stress EF and rest EF at myocardial perfusion SPECT by using $^{201}Tl$ and define possible predictors of EF variability. Materials and Methods: From 2008 June to 2009 February, we analyzed 144 patients undergoing $^{201}Tl$ gated myocardial perfusion SPECT in ASAN medical center. To analyze the data, we use QGS (Quantitative gated SPECT) software, and derived End-systolic volume (ESV), End-diastolic volume (EDV), EF from the result. In this study, we comparatively analyzed stress/rest EF correlation based on stress/rest EF, EDV, ESV and reversibility of myocardial perfusion defect by using paired t-test, Bland-Altman analysis. Results: Mached pairs of stress EF and rest EF demonstrated excellent correlation (r=0.92) with no statistically significant difference (p=0.11). Bland-Altman analysis demonstrated a mean ${\Delta}EF$ was 0.52% (95% confidential interval[CI], -1.17~0.12%). No statistically significant difference between a mean ${\Delta}EF$ and hypothetic mean of 0 (${\Delta}EF$=0) (p=0.10). In the correlation of ${\Delta}EF$ according to stress/rest EDV and ESV, except rest ESV of <28mL (p<0.05), there was no statistically significant difference. In the correlation of ${\Delta}EF$ according to reversibility of perfusion defect, patients with reversible perfusion defect has statistically significant difference of ${\Delta}EF$ (p<0.05). ${\Delta}EF$ of stress/rest EF showed no statistically significant difference except 55% of rest EF (p<0.05). Conclusion: Like studies with $^{99m}Tc$-MIBI, there was generally no statistically significant difference between stress and rest EF in this study results. However a stress EF of <55%, a rest ESV of <28mL and patients with reversible perfusion defect showed statistically significant difference in ${\Delta}EF$. If performing $^{201}T$ myocardial perfusion SPECT to patients with abnormal cardiac function or reversible perfusion defect, consider this study results and apply it. We expect this study results could be useful predictors of ${\Delta}EF$ variability.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.222-227
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• 2000

Purpose: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-Tl-SPECT) with those by gated blood pool (GBP) scan. Materials and Methods: Eighteen subjects underwent g-Tl-SPECT and GBP scan. After reconstruction of g-Tl-SPECT, we measured EF with Cedars software. The comparison of the EF with g-Tl-SPECT and GBP scan was assessed by correlation analysis and Bland Altman plot. Results: The estimates of EF were significantly different (p<0.05) with g-Tl-SPECT ($40%{\pm}14%$) and GBP scan ($43%{\pm}14%$). There was an excellent correlation of EF between g-Tl-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GBP scan and g-Tl-SPECT was +3.2% Ninety-five percent limits of agreement were ${\pm}9.8%$. EF between g-Tl-SPECT and GBP scan were in poor agreement. Conclusion: The estimates of EF by g-Tl-SPECT was well correlated with those by GBP scan. However, EF of g-Tl-SPECT doesn't agree with EF of GBP scan. EF of g-Tl-SPECT can't be used interchangeably with EF of GBP scan.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.685-692
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• 2005

Background: Wall motion abnormalities may be a significant predictor for long-term survival after coronary bypass surgery (CABG). The aim of this study is to see whether post-infarction wall motion abnormality of left ventricle affect on the long-term survival after CABG. Material and Method: One-hundred and thirty-three patients (male/female, 92/41) undergoing CABG more than 9 years ago were included in this study. Fifty-six patients (M/F, 42/14; mean age, $59.2\pm9.2$ years) with LV wall motion abnormalities were compared to 77 patients (M/F, 50/27; mean age, $58.0\pm7.6$ years) without the wall motion abnormalities. Most patients (112/133, $84.2\%$) had undergone on-pump CABG with the in-situ left internal thoracic artery and free grafts of saphenous vein, in which the proximal and distal anastomoses were done for the single aortic cross-clamping period. Result: Ejection fraction of left ventricle was lower in the group with LV wall motion abnormalities (mean ejection fraction, $48.7\pm13.2\%$) compared to the group without wall motion abnormalities (mean ejection fraction, $57.1\pm10.1\%$)(p=0.0001). Risk­unadjusted survivals after CABG in the group without wall motion abnormalities were $85.7\pm4.0\%,\;76.2\pm4.9\%,\;and\;57.2\pm10.3\%$ at 5, 10, and 13 years, respectively, and in the group with wall motion abnormalities were $80.4\pm5.3\%,\;58.7\pm7.3\%,\;and\;51.9\pm7.9\%$ at 5, 10, and 13 years, respectively (p=0.1). In univariate analysis, predictable factors of long-term survival in the patients with LV wall motion abnormalities were LV ejection fraction and post operative outpatient treatment. In multivariate analysis, predictable factor of long-term survival in the patients with the wall motion abnormalities was postoperative outpatient treatment, and that in those without the wall motion abnormalities was female. Conclusion: Although there was no significant survival difference after CABG between the group with LV wall motion abnormalities and that without wall motion abnormalities, the survival in the group with wall motion abnormalities seems to be more decreased. For the patients with LV wall motion abnormalities after myocardial infarction, the post-CABG outpatient treatment is suggested to be an important factor for the long-term survival.

• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.381-392
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• 2000

Purpose: We compared the reproducibility of $^{201}Tl\;and\;^{99m}Tc$-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm Materials and Methods: Gated SPECT acquisition was repeated in the same position in 30 patients who received $^{201}Tl$ and in 26 who received $^{99m}Tc$-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on $^{201}Tl\;and\;^{99m}Tc$-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on $^{201}Tl$ gated SPECT was compared with that of $^{99m}Tc$-MIBI gated SPECT Results: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of $^{201}Tl$ (r=0.928 to 0.986; p<0.05) and $^{99m}Tc$-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated $^{99m}Tc$-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated $^{201}Tl$ gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes und EFs were smaller by repeated $^{99m}Tc$-MIBI gated SPECT (EDV: 2.1 ml, ESV 2.7 ml and EF: 2.3%) than by repeated $^{201}Tl$ gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). Conclusion: $^{99m}Tc$-MIBI provides more reproducible volumes and EF than $^{201}Tl$ on repeated acquisition gated SPECT. $^{99m}Tc$-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.

• The Korean Journal of Nuclear Medicine
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• v.37 no.3
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• pp.153-161
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• 2003

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.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.168-179
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• 2007

Background: The recent trend of an increasing number of patients with acute cardiogenic shock or chronic congestive heart failure following myocardial infarction, as well as the considerable number who can not be weaned from cardiopulmonary bypass after open heart surgery, call for immediate efforts to develop affordable ventricular assist devices that are suitable for the Korean physique. Recently, a pneumatic pulsatile ventricular assist device (VAD), named DKUH-75, has been developed by the Department of Biomedical Engineering, in collaboration with the Department of Thoracic and Cardiovascular Surgery of Dankook University College of Medicine. The feasibility of the DKUH-75 VAD was evaluated on the bases of common hemodynamic variables and echocardiographic measurements in pigs, which are subjected to an acute cardiogenic shock state following myocardial infarction, using a novel coronary artery ligation method employing the ischemic preconditioning concept. Material and Method: Acute cardiogenic shock was induced in 10 Yorkshire Landrace Duroc strain pigs by ligating the left anterior descending coronary artery via an ischemic preconditioning process. The hemodynamic variables were monitored, with epicardial echocardiographic measurements performed before and one hour after the ligation. The DKUH-75 VAD was implanted into 5 pigs one hour after the onset of the shock. The hemodynamic variables and echocardiographic measurements were taken one hour after installation of the VAD. Result: The systolic, diastolic and mean systemic arterial pressures were significantly decreased in all the experimental animals one hour after the ligation. The systolic, diastolic and mean pulmonary arterial pressures were increased (Eds note: this completely contradicts the preceding statement? However, if you mean the non-experimental animals this should be stated?). The left ventricular end diastolic pressure (LVEDP) was increased, but the cardiac index decreased, An increase in the left ventricular end systolic dimension and decreases in the fractional shortening and ejection fraction were observed all animals one hour after the coronary artery ligation. In all 5 of the VAD implanted pigs, the systolic and mean systemic arterial pressures were increased, and the pulmonary arterial pressures decreased one hour after the implantation; the LVEDP decreased, but the cardiac index was significantly increased, In the echocardiographic measurements, the left ventricular end systolic dimension decreased after the implantation of the VAD, but the fractional shortening and ejection fraction significantly increased. Conclusion: Significant improvements in the hemodynamic variables and echocardiographic measurements were observed in the 5 VAD implanted animals one hour after installation, which had been subjected to an acute cardiogenic shock state by ligation of the coronary artery, indicating that the DKUH-75 VAD could help in the recovery of the myocardial function. This suggests that the DKUH-75 VAD is feasible in the short term in relation to an acute cardiogenic shock state due to myocardial infarction.

• Journal of radiological science and technology
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• v.47 no.5
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• pp.333-344
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• 2024

The purpose of this study is to identify predictors of cardiac arterial stenosis severity. The subjects of the study were patients who underwent cardiovascular angiography. The predicted index was evaluated by the ankle brachial index, the left ventricular ejection fraction and the aortic valve velocity max of echocardiography. The severity of cardiac arterial stenosis increased in the elderly in their 70s and 80s. In cross-analysis of stenosis, the ankle brachial index was associated three times higher than the left ventricular ejection fraction and the aortic valve velocity max. Even in the correlation analysis, the ankle brachial index showed a high correlation as a predictor. Regression analysis showed that if the ankle brachial index was lower than 0.9, the probability of stenosis increased 6.1 times compared to the normal study subjects. and measurement of left ventricular ejection fraction revealed that subjects with low left ventricular ejection fraction were 3.3 times more likely to develop 3VD. Therefore, the predictor of cardiac artery stenosis was identified by the ankle brachial index and left ventricular ejection fraction.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.552-557
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• 2007

Background: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. Material and Method: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: ${\le}290$ pg/mL) and the high BNP group (n=29, BNP: >290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. Result: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p<0.05). Further, BNP has linear correlation with the pulmonary capillary wedge pressure (r=0.590, p<0.001). Using the cut-off value of 620 pg/mL, the BNP predicted a high PCWP (>12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: $0.900{\pm}0.045$, p<0.001). Conclusion: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.

• Korean Journal of Clinical Laboratory Science
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• v.48 no.4
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• pp.394-400
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• 2016

The b-type natriuretic peptide (BNP) values and increase on functional disorder in the ventricle, and are used as an index to diagnose heart failure and predict the prognosis. BNP values is known to be relevant to dyssystole in congestive heart failure. This study aimed to identify correlation between the BNP values and the items that indicate the diastolic function in echocardiography. The research divided 188 patients who went through the BNP test and echocardiography in the hospital into the groups with the BNP values; <100, 100-300, 301-600, 601-900, and >901 pg/mL. As the BNP values increase, there was relevance with the echocardiography items of ejection fraction, size of left atrium, E velocity, A velocity, Deceleration time, E/A ratio, E', A', S' and E/E'. In comparison on the groups divided based on the BNP values, E/E' had the highest relevance. The research also categorized 67 patients who diagnosed with heart failure. In comparison on the groups of the heart failure patients, the BNP values of the three groups of Grade I: $623.0{\pm}459.7pg/mL$, Grade II: $1013.2{\pm}1155.1pg/mL$ and Grade III: $1693.4{\pm}1544.0pg/mL$, respectively (p<0.01). As the grade was higher, there was a higher relevance with the echocardiography items of ejection fraction, size of left atrium, E velocity, A velocity, Deceleration time, E/A ratio, E', A', S' and E/E' (p<0.001). Higher BNP values had a higher relevance with the items that indicate the diastolic function in echocardiography and the BNP values of the Restrictive physiology group were the highest in echocardiography. So the BNP values was thought to be valuable to predict diastolic function of heart.