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

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

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.

Results

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.

Conclusion

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.

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Figure 1
Figure 2

Abbreviations

HF:

Heart failure

RV:

Right ventricle/ventricular

ROI:

Region of interest

LV:

left ventricle/ventricular

LAD:

Left anterior descending artery

LCX:

Left circumflex coronary artery

RCA:

Right coronary artery

SPECT:

Single photon emission tomography

MPI:

Myocardial perfusion imaging

MBF:

myocardial blood flow

CAD:

Coronary artery disease

CABG:

Coronary artery bypass grafting

PCI:

Percutaneous intervention

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Disclosure

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.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research building 306, 1900 University BLVD, Birmingham, AL, 35294, USA

    Ayman A. Farag MD, Jack Heo MD, Lindsey Tauxe BS, Ami E. Iskandrian MD, MASNC & Fadi G. Hage MD, FASNC

  2. Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Pradeep Bhambhvani MD

  3. Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Fadi G. Hage MD, FASNC

  4. Cedars Sinai Medical Center, Los Angeles, CA, USA

    Guido Germano PhD & Paul Kavanagh MS

Authors
  1. Ayman A. Farag MD
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  2. Jack Heo MD
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  3. Lindsey Tauxe BS
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  4. Pradeep Bhambhvani MD
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  5. Guido Germano PhD
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  6. Paul Kavanagh MS
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  7. Ami E. Iskandrian MD, MASNC
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  8. Fadi G. Hage MD, FASNC
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Corresponding author

Correspondence to Fadi G. Hage MD, FASNC.

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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Alberto Cuocolo, MD.

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Farag, A.A., Heo, J., Tauxe, L. et al. Detection and quantitation of right ventricular reversible perfusion defects by stress SPECT myocardial perfusion imaging: A proof-of-principle study. J. Nucl. Cardiol. 26, 266–271 (2019). https://doi.org/10.1007/s12350-017-0954-4

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  • DOI: https://doi.org/10.1007/s12350-017-0954-4

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