The diagnostic and prognostic value of ECG-gated SPECT myocardial perfusion imaging.

Department of Medicine, Rush University Medical Center, Chicago, Illinois 60612-3864, USA.
Journal of Nuclear Medicine (Impact Factor: 5.56). 06/2004; 45(5):912-21.
Source: PubMed

ABSTRACT Since the development of gated SPECT imaging approximately 10 y ago, this technique is now almost universally used as an adjunct for radionuclide perfusion imaging, enabling the assessment of perfusion along with determination of regional and global left ventricular function in the same examination. The gated SPECT determination of the left ventricular ejection fraction and volumes has been extensively validated. Additionally, this method allows for the improved identification of soft-tissue artifacts and enhances the detection of multivessel coronary artery disease. Furthermore, gated SPECT provides powerful information for the risk assessment of patients with known or suspected coronary artery disease and aids in the assessment of myocardial viability. Gated SPECT imaging has clearly become an integral part of radionuclide myocardial perfusion imaging.

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    ABSTRACT: Objective A high transient ischemic dilatation ratio (TID) for the left ventricle (LV) from a gated myocardial perfusion imaging (G-MPI) study is widely believed to be associated with significant coronary artery disease (CAD). We have investigated the relationship between TID and CAD for our male Saudi Arabian patient population. Methods In this retrospective study, all male Saudi Arabian patients who underwent a two-day G-MPI study using Tc99m MIBI during the year 2011 having a TID ⩾ 1.20 were included. Quantitative perfusion and gated parameters were obtained using Cedar Sinai’s AutoQuant software version 3.0, 2003, Means of summed stress scores, summed rest scores and summed difference scores (SSS, SRS, SDS, respectively), stress and rest ejection fraction (EF) were calculated. Visual interpretation was performed to classify the perfusion as normal, fixed, mixed (fixed and reversible defects), single reversible or multiple reversible defects. Coronary angiograms were assessed as normal with no CAD, single vessel, two-vessel or three-vessel disease. Correlations between the TID and other parameters were studied using analysis of variance (ANOVA) with IBM-SPSS version 20. Results A total of 52 male patients had a high TID of ⩾1.20 (mean 1.30 ± 0.13). Ten patients had a SSS of 0–3 and 16 were classified as normal by visual assessment. Stress EF (mean 50.4 ± 12%) was lower than the rest EF (mean 56.6 ± 12.8%) with the difference being statistically significant (Students paired t-test, p = 0.001). Angiography results were available in 44 patients, 3 having a normal angiogram, 24 having three vessel disease, 7 having two vessel disease and 10 having one vessel disease. Five patients with normal perfusion and SSS = 0–3 had CAD as seen on a coronary angiography. CAD on coronary angiography showed a significant correlation with perfusion abnormalities as assessed by visual interpretation (p = 0.002). TID showed a significantly correlation with both perfusion abnormalities (p = 0.009), as assessed by visual interpretation, and with Summed difference scores, SDS (p = 0.000). Conclusion A high TID on G-MPI was a very sensitive indicator of significant CAD. In patients with normal perfusion and high TID further workup is warranted.
    Journal of the Saudi Heart Association 01/2013;
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    ABSTRACT: Stress-induced ischemia may cause a decrease in left ventricular ejection fraction (EF). We evaluated the variation in early postexercise EF (S-EF) compared with rest EF (R-EF) in different clinical settings to detect ventricular dysfunction. We also correlated ventricular dysfunction with an angiographic score, the Syntax score, in a subgroup of ischemic patients. Gated-SPECT images were acquired 12 min after exercise stress and at rest in 1481 patients. Patients were classified as controls, negative for ischemia, mildly ischemic, moderately/severely ischemic, necrotic, and necrotic with ischemia. Mean end-diastolic volume, end-systolic volume, and EF were compared in each group. The ratio between stress to rest EF was indicated as the functional score. Angiography results were collected for 55% of moderately/severely ischemic patients. Sixty-one angiographies were also completed with Syntax score evaluation. In negative, necrotic, and mildly ischemic patients no differences were found between S-EF and R-EF. An opposite trend was observed in moderately/severely ischemic patients with a decrement of S-EF compared with R-EF (54.80±11.33 vs. 57.79±11.14; P<0.0001). Coronary artery disease was confirmed by angiography in 93% of moderately/severely ischemic patients. In 61 patients who underwent Syntax score evaluation, significant correlation was observed with functional score. Significant decrease in functional score was found in patients with coronary artery bypass graft indication compared with patients with percutaneous coronary intervention or medical indication. Early poststress gated-SPECT acquisition allows the detection of ventricular dysfunction in moderately/severely ischemic disease and provides additional information when directing patients to angiography and revascularization.
    Nuclear Medicine Communications 04/2014; · 1.37 Impact Factor
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    ABSTRACT: Although the use of myocardial perfusion imaging (MPI) for prognostic purposes in general population is well understood, its role in very elderly patients is not extensively studied.
    Journal of Nuclear Cardiology 09/2014; · 2.65 Impact Factor


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