Skip to main content
SpringerLink
Log in

Transient postischemic stunning evaluation by stress gated Tl-201 SPECT myocardial imaging: Effect on systolic left ventricular function

  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Transient postischemic stunning (TIS) has been reported in images obtained 1?2 to 1 hour after stress with technetium 99m tracers but has not been investigated in images obtained shortly after stress with thallium 201. We also quantified the global extent and severity of TIS, which has not been done previously.

Methods and Results

We evaluated 82 patients with either treadmill or dobutamine stress Tl-201 myocardial perfusion imaging. Images were semiquantitatively examined with a 20-segment model. The extent and severity of myocardial ischemia and TIS were assessed by the summed difference score from the early and delayed scores of perfusion, wall motion (WM), and wall thickening (WT). The mean left ventricular ejection fraction (LVEF) was significantly lower in early images than in delayed images in patients with ischemia (P < .01), TIS by WM (P < .001), and TIS by WT (P < .001), and the LVEF difference was more significantly different as the summed difference score of perfusion, WM, or WT increased. No significant LVEF difference was seen in patients with ischemia who did not have TIS.

Conclusions

In stress gated Tl-201 single photon emission computed tomography myocardial perfusion imaging, early TIS is frequently seen in patients with ischemia and is equivalently detected by WM and WT assessments. Significant exercise-induced transient left ventricular global dysfunction is associated with more severe and extensive ischemia and can be predicted by the measurement of the extent and severity of TIS from the same images.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bolli R. Why myocardial stunning is clinically important. Basic Res Cardiol 1998;93:169–72.

    Article  PubMed  CAS  Google Scholar 

  2. Bolli R. Common methodological problems and artifacts associated with studies of myocardial stunning in vivo. Basic Res Cardiol 1995;90:257–62.

    Article  PubMed  CAS  Google Scholar 

  3. Bolli R, Zhu WX, Thornby JI, O’Neal PG, Roberts R. Time course and determinants of recovery of function after reversible ischemia in conscious dogs. Am J Physiol 1988;254:H102–14.

    Google Scholar 

  4. Bolli R, Patel BS, Hartley CJ, Thornby JI, Jeroudi MO, Roberts R. Nonuniform transmural recovery of contractile function in the “stunned” myocardium. Am J Physiol 1989;257:H375–85.

    Google Scholar 

  5. Bolli R, Marban E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev 1999;79:609–34.

    PubMed  CAS  Google Scholar 

  6. Johnson LL, Verdesca SA, Aude WY, Xavier RC, Nott LT, Campanella MW, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997; 30:1641–8.

    Article  PubMed  CAS  Google Scholar 

  7. Paul AK, Hasegawa S, Yoshioka J, Tsujimura E, Yamaguchi H, Tokita N, et al. Exercise-induced stunning continues for at least one hour: evaluation with quantitative gated single-photon emission tomography. Eur J Nucl Med 1999;26:410–5.

    Article  PubMed  CAS  Google Scholar 

  8. Borges-Neto S, Javaid A, Shaw LK, Kong DF, Hanson MW, Pagnanelli RA, et al. Poststress measurements of left ventricular function with gated perfusion SPECT: comparison with resting measurements by using a same-day perfusion-function protocol. Radiology 2000;215:529–33.

    PubMed  CAS  Google Scholar 

  9. Hashimoto J, Kubo A, Iwasaki R, Iwanaga S, Mtamura H, Ogawa S, et al. Gated single-photon emission tomography imaging protocol to evaluate myocardial stunning after exercise. Eur J Nucl Med 1999;26:1541–6.

    Article  PubMed  CAS  Google Scholar 

  10. Lee DS, Yeo JS, Chung JK, Lee MM, Lee MC. Transient prolonged stunning induced by dipyridamole and shown on 1- and 24-hour poststress 99mTc-MIBI gated SPECT. J Nucl Med 2000;41:27–35.

    PubMed  CAS  Google Scholar 

  11. Ambrosio G, Betocchi S, Pace L, Losi MA, Perrone-Filardi P, Soricelli A, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina. Evidence of myocardial stunning in patients with coronary artery disease. Circulation 1996;94:2455–64.

    PubMed  CAS  Google Scholar 

  12. Robertson WS, Feigenbaum H, Armstrong WF, Dillon JC, O’Donnel J, McHenry PW. Exercise echocardiography: a clinically practical addition in the evaluation of coronary artery disease. J Am Coll Cardiol 1983;2:1085–91.

    PubMed  CAS  Google Scholar 

  13. Kloner RA, Allen J, Cox TA, Zheng Y, Ruiz CE. Stunned left ventricular myocardium after exercise treadmill testing in coronary artery disease. Am J Cardiol 1991;68:329–34.

    Article  PubMed  CAS  Google Scholar 

  14. Scognamiglio R, Ponchia A, Fasoli G, Miraglia G, DallaVolta S. Exercise-induced left ventricular dysfunction in coronary artery disease: a model for studying the stunned myocardium in man. Eur Heart J 1991;12:16–19.

    PubMed  Google Scholar 

  15. Diamond GA, Staniloff HM, Forrester JS, Pollock BH, Swan HJ. Computer-assisted diagnosis in the non-invasive evaluation of patients with suspected coronary artery disease. J Am Coll Cardiol 1983;1:444–55.

    Article  PubMed  CAS  Google Scholar 

  16. Germano G, Erel J, Kiat H, Kavanagh PB, Berman DS. Quantitative LVEF and qualitative regional function from gated thallium-201 perfusion SPECT. J Nucl Med 1997;38:749–54.

    PubMed  CAS  Google Scholar 

  17. Mazzanti M, Germano G, Kiat H, Alexanderson E, Friedman JD, Hachamovitch R, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612–20.

    Article  PubMed  CAS  Google Scholar 

  18. Leppo JA, Meerdink DJ. Comparison of myocardial uptake of a technetium-labeled isonitrile analogue and thallium. Circ Res 1989;56:632–9.

    Google Scholar 

  19. Marshall RC, Leidholdt EMJ, Zhang D-Y, Barnett CA. Technetium-99m hexakis 2-methoxy-2-isobutyle-isonitrile and thallium-201 extraction, washout and retention at varying flow rates in rabbit heart. Circulation 1990;82:998–1007.

    PubMed  CAS  Google Scholar 

  20. Allman KC, Berry J, Sucharski LA, et al. Determination of extent and location of coronary artery disease in patients without prior myocardial infarction by thallium-201 tomography with pharmacologic stress. J Nucl Med 1992;33:2067–73.

    PubMed  CAS  Google Scholar 

  21. Hicks RJ. Myocardial perfusion scintigraphy techniques using single photon radiotracers. In: Murray IPC, Ell PJ, editors. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. London: Churchill Livingstone; 1998. p. 1333–51.

    Google Scholar 

  22. Maunoury C, Chen C, Chua K, Thompson C. Quantification of left ventricular function with thallium-201 and technetium-99m- sestamibi myocardial gated SPECT. J Nucl Med 1997;38: 958–61.

    PubMed  CAS  Google Scholar 

  23. Itti E, Rosso J, Damien P, Auffret M, Thirion JP, Meignan M. Assessment of ejection fraction with Tl-201 gated SPECT in myocardial infarction: precision in a rest-redistribution study and accuracy versus planar angiography. J Nucl Cardiol 2001;8:31–9.

    Article  PubMed  CAS  Google Scholar 

  24. He Z, Cwaijg E, Preslar J, Mahmarian J, Verani M. Accuracy of left ventricular ejection fraction determined by gated myocardial perfusion SPECT with Tl-201 and Tc-99m sestamibi: comparison with first pass radionuclide angiography. J Nucl Med 1999;6:412–7.

    CAS  Google Scholar 

  25. Tadamura E, Kudoh T, Motooka M, et al. Assessment of regional and global left ventricular function by reinjection Tl-201 and rest Tc-99m sestamibi ECG gated SPECT: comparison with three-dimensional magnetic resonance imaging. J Am Coll Cardiol 1999;33:991–7.

    Article  PubMed  CAS  Google Scholar 

  26. Hyun IY, Kwan J, Park KS, Lee WH. Reproducibility of Tl-201 and Tc-99m sestamibi gated myocardial perfusion SPECT measurement of myocardial function. J Nucl Cardiol 2001;8:182–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine Service, Department of Radiology, St Vincent’s Catholic Medical Centers of New York, 153 W 11th St, 10011, New York, NY

    Sherif I. Heiba, Jonas Santiago, Suman Jana, Fuat Dede & Hussein M. Abdel-Dayem

  2. New York Medical College, St Vincent’s Catholic Medical Centers of New York, 153 W 11th St, 10011, New York, NY

    Sherif I. Heiba & Hussein M. Abdel-Dayem

  3. Department of Medicine, Cardiology Service, St Vincent’s Catholic Medical Centers of New York, New York, NY

    Majid Mirzaitehrane

Authors
  1. Sherif I. Heiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonas Santiago
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Majid Mirzaitehrane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suman Jana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fuat Dede
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hussein M. Abdel-Dayem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hussein M. Abdel-Dayem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heiba, S.I., Santiago, J., Mirzaitehrane, M. et al. Transient postischemic stunning evaluation by stress gated Tl-201 SPECT myocardial imaging: Effect on systolic left ventricular function. J Nucl Cardiol 9, 482–490 (2002). https://doi.org/10.1067/mnc.2002.123855

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1067/mnc.2002.123855

Key Words

Search

Navigation