Journal of Nuclear Cardiology

, Volume 25, Issue 2, pp 652–660 | Cite as

Left ventricular functional parameters by gated SPECT myocardial perfusion imaging in a Latin American country

  • Miguel Kapitan
  • Alvaro Beltran
  • Mario Beretta
  • Fernando Mut
International Corner



There is paucity of data on left ventricular (LV) functional parameters using gated SPECT myocardial perfusion imaging (MPI) from the Latin American region. This study provides detailed information in low-risk patients both at rest and during exercise.

Methods and Results

We studied 90 patients (50 men) with a very low likelihood of coronary artery disease. Gated-SPECT MPI was performed with Tc-99m MIBI using a 2-day protocol, with 16 frames/R–R cycle. The LV ejection fraction and volumes were not different between the rest and post-stress images. LVEF was 68 ± 7% post-stress and 70 ± 7% at rest in women, and 62 ± 7% and 63 ± 7%, respectively, in men (P = .19, .26). LV volumes were larger in men than women (P < .01). There were no differences in most variables obtained at rest or post-stress. Transient ischemic dilatation was similar, with upper limits of 1.20 and 1.19 in women and men, respectively (P = NS).


These data could prove helpful for the interpretation of gated SPECT MPI data in Latin America using identical protocol as used in this study.


Gated-SPECT functional parameters Latin America 



End-diastolic volume


Ejection fraction


End-systolic volume


Time to peak filling rate


Mean filling rate during first third of diastole




Peak ejection rate


Peak filling rate


Single-photon emission computed tomography


Transient ischemic dilatation



The authors (Drs. M. Kapitan, A. Beltran, M. Beretta and F. Mut), declare no conflicts of interest. No special financial assistance was received for this work.


  1. 1.
    Organización Panamericana de la Salud/Organización Mundial de la Salud/Información y Análisis de Salud: Situación de Salud en las Américas: Indicadores Básicos 2015. Washington, DC: EUA; 2015.Google Scholar
  2. 2.
    OPS. Salud en las Américas. Washington, DC: OPS; 2007; vol I, p.132.Google Scholar
  3. 3.
    Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011.Google Scholar
  4. 4.
    Lanas F, Avezum A, Bautista L, Díaz R, Luna M, Islam S, et al. Risk factors for acute myocardial infarction in Latin America, The INTERHEART Latin American Study. Circulation. 2007;115:1067-74.CrossRefPubMedGoogle Scholar
  5. 5.
    Marcassa C, Bax JJ, Bengel F, Hesse B, Petersen CL, Reyes E, et al. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: A position statement. Eur Heart J. 2008;29:557-63.CrossRefPubMedGoogle Scholar
  6. 6.
    Cerqueira M. Nuclear cardiology: finally a one-stop shop for diagnosis, risk stratification, and management of coronary artery disease. Clin Cardiol. 2006;29:126-33.CrossRefGoogle Scholar
  7. 7.
    Cremer P, Hachamovitch R, Tamarappoo B. Clinical decision making with myocardial perfusion imaging in patients with known or suspected coronary artery disease. Semin Nucl Med. 2014;44:320-9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900-7.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim YH, Ahn JM, Park DW, Song HG, Lee JY, Kim WJ, et al. Impact of ischemia-guided revascularization with myocardial perfusión imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012;60:181-90.CrossRefPubMedGoogle Scholar
  10. 10.
    Chen J, Garcia EV, Bax JJ, Iskandrian AE, Borges-Neto S, Soman P. SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony. J Nucl Cardiol. 2011;18:685-94.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Vitola J, Shaw L, Allam A, Orellana P, Peix A, Ellmann A, et al. Assessing the need for nuclear cardiology and other advanced cardiac imaging modalities in the developing world. J Nucl Cardiol. 2009;16:956-61.CrossRefPubMedGoogle Scholar
  12. 12.
    Páez D, Orellana P, Gutiérrez C, Ramirez R, Mut F, Torres L. Current status of Nuclear Medicine practice in Latin America and the Caribbean. J Nucl Med. 2015;56:1629-34.CrossRefPubMedGoogle Scholar
  13. 13.
    Watson DD. Acquisition, processing, and quantification of nuclear cardiac images. In: Iskandrian AE, Garcia EV, editors. Nuclear cardiac imaging: Principles and applications. New York: Okford University Press; 2008. p. 97.Google Scholar
  14. 14.
    Enfermedad de Chagas. Depto. de Parasitología y Micología, Instituto de Higiene, Universidad de la República, 2007. Enfermedad de Chagas. Depto. de Parasitología y Micología, Instituto de Higiene, Universidad de la República; 2007. Accessed 26 Sep 2016
  15. 15.
    Nakajima K, Okuda K, Nyström K, Richter J, Minarik D, Wakabayashi H, et al. Improved quantification of small hearts for gated myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2013;40:1163-70.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hambye AS, Vervaet A, Dobbeleir A. Variability of left ventricular ejection fraction and volumes with quantitative gated SPECT: Influence of algorithm, pixel size and reconstruction parameters in small and normal-sized hearts. Eur J Nucl Med Mol Imaging. 2004;31:1606-13.CrossRefPubMedGoogle Scholar
  17. 17.
    Kondo C, Watanabe E, Momose M, Fukushima K, Abe K, Hagiwara N, et al. In vivo validation of gated myocardial SPECT imaging for quantification of small hearts: Comparison with cardiac MRI. EJNMMI Res. 2016;6:9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lear SA, Brozic A, Myers JN, Ignaszewski A. Exercise stress testing. An overview of current guidelines. Sports Med. 1999;27:285-312.CrossRefPubMedGoogle Scholar
  19. 19.
    Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995;36:2138-47.PubMedGoogle Scholar
  20. 20.
    Rozanski A, Nichols K, Yao S-S, Malholtra S, Cohen R, DePuey EG. Development and application of normal limits for left ventricular ejection fraction and volume measurements from 99mTc sestamibi myocardial perfusion gated SPECT. J Nucl Med. 2000;41:1445-50.PubMedGoogle Scholar
  21. 21.
    Lomsky M, Johansson L, Gjertsson P, Björk J, Edenbrandt L. Normal limits for left ventricular ejection fraction and volumes determined by gated single photon emission computed tomography–a comparison between two quantification methods. Clin Physiol Funct Imaging. 2008;28:169-73.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Nakajima K, Kusuoka H, Nishimura S, Yamashina A, Nishimura T. Normal limits of ejection fraction and volumes determined by gated SPECT in clinically normal patients without cardiac events: A study based on the J-ACCESS database. J Nucl Med Mol Imaging. 2007;34:1088-96.CrossRefGoogle Scholar
  23. 23.
    De Bondt P, Van de Wiele C, De Sutter J, De Winter F, De Backer G, Dierckx RA. Age- and gender-specific differences in left ventricular cardiac function and volumes determined by gated SPET. Eur J Nucl Med. 2001;28:620-4.CrossRefPubMedGoogle Scholar
  24. 24.
    Ababneh AA, Sciacca RR, Kim B, Bergmann SR. Normal limits for left ventricular ejection fraction and volumes estimated with gated myocardial perfusion imaging in patients with normal exercise test results: Influence of tracer, gender, and acquisition camera. J Nucl Cardiol. 2000;7:661-8.CrossRefPubMedGoogle Scholar
  25. 25.
    Sharir T, Kang X, Germano G, Bax JJ, Shaw LJ, Gransar H, et al. Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes. J Nucl Cardiol. 2006;13:495-506.CrossRefPubMedGoogle Scholar
  26. 26.
    Akincioglu C, Berman DS, Nishina H, Kavanagh PB, Slomka PJ, Abidov A, et al. Assessment of diastolic function using 16-frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. J Nucl Med. 2005;46:1102-8.PubMedGoogle Scholar
  27. 27.
    Nakajima K, Matsumoto N, Kasai T, Matsuo S, Kiso K, Okuda K. Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med. 2016;30:188--99.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, et al. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. J Nucl Cardiol. 2016;23:530-41.CrossRefPubMedGoogle Scholar
  29. 29.
    Maeder MT, Kaye DM. Heart failure with normal left ventricular ejection fraction. J Am Coll Cardiol. 2009;5:905-18.CrossRefGoogle Scholar
  30. 30.
    Higuchi T, Nakajima K, Taki J, Kinuya S, Bunko H, Tonami N. Assessment of left ventricular systolic and diastolic function based on the edge detection method with myocardial ECG-gated SPET. Eur J Nucl Med. 2001;28:1512-6.CrossRefPubMedGoogle Scholar
  31. 31.
    Iskandrian AE, Hage FG, Shaw LJ, Mahmarian JJ, Berman DS. Serial myocardial perfusion imaging: Defining a significant change and targeting management decisions. JACC Cardiovasc Imaging. 2014;7:79-96.CrossRefPubMedGoogle Scholar
  32. 32.
    DePuey EG. Sources of variability of gated myocardial perfusion SPECT quantitative parameters. J Nucl Cardiol. 2016;23:818-23.CrossRefPubMedGoogle Scholar
  33. 33.
    Moslehi M, Alidadi S, Assadollahi E, Assadi M. Do ejection fraction and other gated stress rest myocardial perfusion parameters differ by age and gender? Nucl Med Rev Cent East Eur. 2015;18:7-12.CrossRefPubMedGoogle Scholar
  34. 34.
    Kurisu S, Sumimoto Y, Ikenaga H, Watanabe N, Ishibashi K, Dohi Y, et al. Effects of left ventricular size on the accuracy of diastolic parameters derived from myocardial perfusion SPECT: Comparison with tissue Doppler echocardiography. Ann Nucl Med. 2016;30:645-51.CrossRefPubMedGoogle Scholar
  35. 35.
    Yamada AT, Neto C, de Carvalho G, Soares J Jr., Giorgi MC, Araújo F, et al. Gender differences in ventricular volumes and left ventricle ejection fraction estimated by myocardial perfusion imaging: Comparison of Quantitative Gated SPECT (QGS) and Segami software programs. Arq Bras Cardiol. 2007;88:285-90.CrossRefPubMedGoogle Scholar
  36. 36.
    Navare SM, Wackers FJ, Liu YH. Comparison of 16-frame and 8-frame gated SPET imaging for determination of left ventricular volumes and ejection fraction. Eur J Nucl Med Mol Imaging. 2003;30:1330-7.CrossRefPubMedGoogle Scholar
  37. 37.
    Montelatici G, Sciagrà R, Passeri A, Dona M, Pupi A. Is 16-frame really superior to 8-frame gated SPECT for the assessment of left ventricular volumes and ejection fraction? Comparison of two simultaneously acquired gated SPECT studies. Eur J Nucl Med Mol Imaging. 2008;35:2059-65.CrossRefPubMedGoogle Scholar
  38. 38.
    Del Val Gómez M, Gallardo FG, Peraira R, García A. [Quantification of myocardial scintigraphy in patients with low probability of coronary artery disease. Normal values of thallium-201 gated SPECT]. Rev Esp Med Nucl. 2009;28:193-9.CrossRefPubMedGoogle Scholar
  39. 39.
    Wang SY, Cheng MF, Hwang JJ, Hung CS, Wu YW. Sex-specific normal limits of left ventricular ejection fraction and volumes estimated by gated myocardial perfusion imaging in adult patients in Taiwan: A comparison between two quantitative methods. Nucl Med Commun. 2011;32:113-20.CrossRefPubMedGoogle Scholar
  40. 40.
    Gebhard C, Stähli BE, Gebhard CE, Fiechter M, Fuchs TA, Stehli J, et al. Gender- and age-related differences in rest and post-stress left ventricular cardiac function determined by gated SPECT. Int J Cardiovasc Imaging. 2014;30:1191-9.CrossRefPubMedGoogle Scholar
  41. 41.
    Xu Y, Arsanjani R, Clond M, Hyun M, Lemley M Jr, Fish M, et al. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT. J Nucl Cardiol. 2012;19:465-73.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Chen J, Henneman M, Trimble M, Bax J, Borges-Neto S, Iskandrian A, et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2008;15:127-31.CrossRefPubMedGoogle Scholar
  43. 43.
    Schaefer WM, Lipke CS, Standke D, Kühl HP, Nowak B, Kaiser HJ, et al. Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT. J Nucl Med. 2005;46:1256-63.PubMedGoogle Scholar
  44. 44.
    Kakhki VR, Zakavi SR, Sadeghi R. Comparison of two software in gated myocardial perfusion single photon emission tomography, for the measurement of left ventricular volumes and ejection fraction, in patients with and without perfusion defects. Hell J Nucl Med. 2007;10:19-23.PubMedGoogle Scholar
  45. 45.
    Ather S, Iqbal F, Gulotta J, Aljaroudi W, Heo J, Iskandrian AE, et al. Comparison of three commercially available softwares for measuring left ventricular perfusion and function by gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2014;21:673-81.CrossRefPubMedGoogle Scholar
  46. 46.
    Miao TL, Kansal V, Glenn Wells R, Ali I, Ruddy TD, Chow BJ. Adopting new gamma cameras and reconstruction algorithms: Do we need to re-establish normal reference values? J Nucl Cardiol. 2016;23:807-17.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Miguel Kapitan
    • 1
    • 2
  • Alvaro Beltran
    • 1
  • Mario Beretta
    • 2
  • Fernando Mut
    • 1
    • 2
  1. 1.Nuclear Medicine ServiceItalian HospitalMontevideoUruguay
  2. 2.Nuclear Medicine ServiceSpanish Association HospitalMontevideoUruguay

Personalised recommendations