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Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: Results from the IAEA multi-center study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Transient post-ischemic LV dysfunction due to myocardial stunning in patients with coronary artery disease can be missed by conventional gated SPECT (GSPECT) acquisitions. The aim of this IAEA-sponsored multi-center study was to determine whether early post-exercise imaging is more likely to detect stunning than conventional without adversely affecting image quality or perfusion information.

Methods and Results

Patients undergoing exercise/rest GSPECT were enrolled in this international multicenter study. Post-exercise studies were acquired at 15 ± 5 minutes after radiotracer injection (Stress-1) and repeated at 60 ± 15 minutes (Stress-2). Rest studies (R) were acquired at 60 minutes post injection. A core laboratory quantitatively assessed perfusion pattern and LV blinded to the acquisition time. Ischemia was defined as summed stress score (SDS) ≥4, and stunning was defined as the difference between rest and post-stress LVEF (Δ-LVEF). In the 229 patients enrolled into the study, both image quality and perfusion information were similar between Stress-1 and Stress-2. Post-stress LVEF was associated with both ischemia and time of acquisition, with a significant correlation between SDS and Δ-LVEF, which was stronger at Stress-1 than Stress-2 in the ischemic compared to the non-ischemic population (r = 0.23 vs 0.08, P = 0.10).

Conclusions

Early post-exercise imaging is feasible, and can potentially improve the detection of post-ischemic stunning without compromising image quality and perfusion data

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Acknowledgements

The authors wish to recognize the valuable contributions of the technical and medical staff in their respective institutions. This study was conducted as part of a Co-ordinated Research Project (CRP E1.30.40), supported by the IAEA, Vienna, Austria. No financial conflicts of interest are reported.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Spanish Association Hospital, Montevideo, Uruguay

    Fernando Mut MD

  2. Department of Nuclear Medicine, University and Spedali Civili, Brescia, Italy

    Raffaele Giubbini MD, Francesco Bertagna MD, Carlo Rodella PhD & Luca Camoni MSc

  3. Department of Nuclear Medicine, Quanta Diagnostico & Terapia, Curitiba, Brazil

    Joao Vitola MD & Carlos Cunha MD

  4. Institute of Statistics, University of Ljubljana Medical Faculty, Ljubljana, Slovenia

    Lara Lusa PhD

  5. Department of Nuclear Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Dragana Sobic-Saranovic MD, PhD

  6. Department of Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba

    Amalia Peix MD

  7. Department of Nuclear Medicine, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Dieu Hang Bui MD

  8. Division of Nuclear Medicine, Philippine Heart Center, Quezon, Philippines

    Jerry Obaldo MD

  9. Nuclear Medicine Section, International Atomic Energy Agency, Vienna, Austria

    Diana Paez MD & Maurizio Dondi MD

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  1. Fernando Mut MD
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Correspondence to Raffaele Giubbini MD.

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See related editorial, doi: 10.1007/s12350-014-9972-7.

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Mut, F., Giubbini, R., Vitola, J. et al. Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: Results from the IAEA multi-center study. J. Nucl. Cardiol. 21, 1168–1176 (2014). https://doi.org/10.1007/s12350-014-9983-4

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