Journal of Nuclear Cardiology

, Volume 26, Issue 1, pp 266–271 | Cite as

Detection and quantitation of right ventricular reversible perfusion defects by stress SPECT myocardial perfusion imaging: A proof-of-principle study

  • Ayman A. Farag
  • Jack Heo
  • Lindsey Tauxe
  • Pradeep Bhambhvani
  • Guido Germano
  • Paul Kavanagh
  • Ami E. Iskandrian
  • Fadi G. HageEmail author
Brief Report



In patients with right dominant coronary circulation, the right ventricular (RV) myocardium and the inferior region of the left ventricular (LV) myocardium share a common source of blood flow. We hypothesized that stress/rest SPECT myocardial perfusion imaging (MPI) could detect reversible perfusion defects in the RV in some patients with LV inferior wall perfusion abnormalities.

Material and Methods

We identified 2 groups of patients with LV inferior wall perfusion defects (with or without defects in other regions of LV myocardium) from our database. Patients in group 1 (n = 17) had reversible perfusion defects in the RV free wall by visual analysis, while patients in group 2 (n = 17) did not. The images were processed with filtered back projection and, separately, with iterative reconstruction. The images were then re-processed using an automated quantitative software that is specifically designed to include the RV in the region of interest.


There were 76% men in group 1 and 94% in group 2 (P <0.05). The mean age was 65±20 in group 1 vs. 63±18 years in group 2 (P < 0.05). The stress type was exercise in 30% in group 1 and 35% in group 2, with the remaining patients studied with pharmacological stress testing (P = NS). The presence of RV reversible perfusion defects using filtered back projection was more evident in 13 patients (75%), while it was better seen with iterative reconstruction in 4 patients (25%). By automated analysis, the RV reversible perfusion defect size was 19 ± 14% of RV myocardium.


This proof-of-principle study demonstrates that reversible RV perfusion defects suggestive of ischemia can be detected by SPECT myocardial perfusion imaging in some patients with LV inferior ischemia by visual analysis and can be quantitated by automated programs. Further studies on the diagnostic and prognostic relevance of assessing RV ischemia on SPECT MPI are needed.


Right ventricle ischemia SPECT myocardial perfusion CAD 



Heart failure


Right ventricle/ventricular


Region of interest


left ventricle/ventricular


Left anterior descending artery


Left circumflex coronary artery


Right coronary artery


Single photon emission tomography


Myocardial perfusion imaging


myocardial blood flow


Coronary artery disease


Coronary artery bypass grafting


Percutaneous intervention



Dr. Hage reports research grant support from Astellas Pharma. Some authors (GG, PBK) receive royalties from Cedars-Sinai Medical Center for algorithms incorporated in commercially distributed software that performs automatic quantification of perfusion, function and other cardiac parameters.

Supplementary material

12350_2017_954_MOESM1_ESM.pptx (801 kb)
Supplementary material 1 (PPTX 800 kb)


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Ayman A. Farag
    • 1
  • Jack Heo
    • 1
  • Lindsey Tauxe
    • 1
  • Pradeep Bhambhvani
    • 2
  • Guido Germano
    • 4
  • Paul Kavanagh
    • 4
  • Ami E. Iskandrian
    • 1
  • Fadi G. Hage
    • 1
    • 3
    Email author
  1. 1.Division of Cardiovascular Disease, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Molecular Imaging and Therapeutics, Department of RadiologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Section of CardiologyBirmingham Veterans Affairs Medical CenterBirminghamUSA
  4. 4.Cedars Sinai Medical CenterLos AngelesUSA

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