Association between non-perfusion parameters and presence of ischemia in gated-SPECT myocardial perfusion imaging studies
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Combined assessment of perfusion and function improves diagnostic and prognostic power of gated-SPECT in patients with coronary artery disease. The aim of this study was to investigate whether the presence of stress-induced ischemia is associated with abnormal resting left ventricular (LV) function and intraventricular dyssynchrony.
Methods and Results
Gated-SPECT myocardial perfusion imaging (MPI) at rest and 15 min post-stress was performed in 101 patients, who were divided into three groups: those with stress-induced ischemia (Group 1, n = 58), those with normal scans (Group 2, n = 28), and those with scar but no ischemia (Group 3, n = 15). More extensive perfusion defects were found in patients of Groups 1 and 3 [Summed stress score (SSS): 13 ± 8 and 21 ± 9, respectively]. In Group 2, the mean SSS was 1.5. The mean change in LV ejection fraction (LVEF at stress − LVEF at rest) was higher in Group 1 v. Group 2 patients: −5.54% ± 6.24% vs −2.46% ± 5.56%, p = 0.02. Group 3 patients also had higher values, similar to Group 1: −6.47% ± 8.82%. Patients with ischemia had almost 50% higher end-diastolic volumes than patients with normal MPI. Similarly, end-systolic volumes were almost twice as high in this group (p < 0.0001). In addition, the histogram bandwidth, a measure of intraventricular dyssynchrony, was greater in Group 1.
Baseline differences in left ventricular volumes and degree of dyssynchrony are associated with inducible ischemia on stress testing in a gated-SPECT MPI. Stress-induced ischemia increases the degree of intraventricular dyssynchrony.
KeywordsMyocardial perfusion imaging left ventricular ejection fraction intraventricular synchrony ischemia gated-SPECT
Coronary artery disease
Left ventricular ejection fraction
Myocardial perfusion imaging
Percutaneous coronary intervention
Phase standard deviation
Summed difference score
Summed stress score
Summed rest score
Single photon emission computed tomography
- 99 mTc-MIBI
Technetium-99m methoxy isobutyl isonitrile
This study is part of and was partially funded from the International Atomic Energy Agency (IAEA) Coordinated Research Protocol E1.30.34. We are grateful to Raymond Russell, MD, PhD, for his suggestions and careful review of the manuscript, as well as to Adrienne Hunter, PhD, for her contribution in reviewing.
There is no conflict of interest.
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