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Impact of early post-stress 99mTc sestamibi ECG-gated SPECT myocardial perfusion imaging on the detection of ischemic LV dyssynchrony: an early step in the stunning cascade

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Abstract

Transient alterations in ventricular conduction and synchronized cardiac performance have been reported in experimental models of myocardial ischemia. In post-stress 99mTc-sestamibi-gated-SPECT myocardial perfusion imaging (MPI), the time elapsed between tracer injection and image acquisition could influence the detection of ischemic left ventricular mechanical dyssynchrony (LVMD). We aimed at evaluating whether early vs. delayed post-stress MPI improve ischemic LVMD detection using the phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) and to assess the correlation between stress-induced changes in SD and HB and other functional parameters. We prospectively studied 32 control subjects (Group-1) and 60 ischemic patients (Group-2). Stress-induced changes were calculated as stress minus rest (Δ). LVMD was defined as post-stress increases of either SD or HB. Group-2 showed higher ΔSD and ΔHB in early than in delayed images: early ΔSD: 1.63 (− 0.37 to 4.83) vs. delayed ΔSD: − 0.39 (− 3.82 to 1.74); early ΔHB: 2.50 (− 4 to 12) vs. ΔHB delayed: − 4 (− 15.75 to 4), all p < 0.01. ΔSD and ΔHB correlated linearly with ΔLV-ejection-fraction (EF) and ΔLV-end systolic-volume (ESV) in early images, all p < 0.01. Early images detected LVMD in more patients than delayed scans (78% vs. 38%; p < 0.01) All patients with LVEF drop in early post-stress evaluation had LVMD. Early post-stress images improve ischemic LVMD detection. Ischemic LVEF and LVESV changes correlate with ΔSD and ΔHB.

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Acknowledgements

The authors thank Dr. Roxana Campisi and Dr. Gustavo Giunta for their thoughtful suggestions in the preparation of this manuscript.

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Authors and Affiliations

  1. Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina

    Claudia Mariana Cortés, E. Natalia Aramayo G & Paula Elizabeth Barboza

  2. Department of Physiology, Favaloro University, Buenos Aires, Argentina

    Alberto Crottogini

  3. Department of Images, Favaloro Foundation University Hospital, Buenos Aires, Argentina

    Mario Alberto Embon

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  1. Claudia Mariana Cortés
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  2. E. Natalia Aramayo G
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  3. Paula Elizabeth Barboza
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Correspondence to Claudia Mariana Cortés.

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This study complies with the Declaration of Helsinki of 1964 and all subsequent revisions and was approved by the Ethics Committee of the Favaloro Foundation University Hospital.

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Cortés, C.M., Aramayo G, E.N., Barboza, P.E. et al. Impact of early post-stress 99mTc sestamibi ECG-gated SPECT myocardial perfusion imaging on the detection of ischemic LV dyssynchrony: an early step in the stunning cascade. Int J Cardiovasc Imaging 37, 1789–1798 (2021). https://doi.org/10.1007/s10554-020-02145-4

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