Feasibility and accuracy of gated blood pool SPECT equilibrium radionuclide ventriculography for the assessment of left and right ventricular volumes and function in patients with left ventricular assist devices
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Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs.
Twenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later.
Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC).
t-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.
KeywordsLeft ventricular assist device equilibrium radionuclide ventriculography SPECT right ventricle cardiac imaging
6-Minute walk test
Equilibrium radionuclide ventriculography
Left ventricular assist device
Left ventricular ejection fraction
Multidetector computed tomography
N-Terminal pro-hormone brain natriuretic peptide
Planar equilibrium radionuclide ventriculography
Peak systolic velocity by tissue Doppler imaging
Right ventricular ejection fraction
Tomographic-equilibrium radionuclide ventriculography
Tricuspid annular plane systolic excursion
The authors thank Bernard Estivals and the staff of the department of nuclear medicine of Rangueil for their technical support.
Olivier Lairez, Clément Delmas, Pauline Fournier, Emmanuelle Cassol, Simon Méjean, Pierre Pascal, Antoine Petermann, Camille Dambrin, Vincent Minville, Didier Carrié, Hervé Rousseau, Michel Galinier, Jérôme Roncalli, Bertrand Marcheix, Isabelle Berry have indicated that they have no financial conflict of interest.
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