Skip to main content
SpringerLink
Log in

Worsening of left ventricular ejection fraction induced by dipyridamole on Tl-201 gated myocardial perfusion imaging predicts significant coronary artery disease

  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Vasodilator stress on myocardial perfusion imaging has been found to induce ischcmic stunning, which may present as transient worsening of left ventricular ejection fraction (LVEF) or regional wall motion abnormality. This study aimed to evaluate the significance of stress–induced worsening of LVEF in the diagnosis of coronary artery disease (CAD) on dipyridamole thallium 201 gated single photon emission computed tomography (SPECT).

Methods and Results

The study included 126 patients who underwent dipyridamole Tl–201 gated SPECT and coronary angiography within 3 months. Poststress and 4–hour rest images were obtained, and LVEF was calculated by use of automated software (QGS 3.0). A decrease in LVEF of 6% or greater from rest to poststress was considered significant, and this threshold was determined by the serial reproducibility assessment of Tl–201 gated SPECT. If worsening of LVEF was used as the criterion for detecting significant CAD (<70% coronary stenoses in <1 vessel), the sensitivity, specificity, positive predictive value, and negative predictive value were 35%, 93%, 90%, and 44%, respectively.

Conclusion

Dipyridamole–induced worsening of LVEF, as shown by Tl–201 gated SPECT, is a valuable nonperfusion marker of significant CAD. Although the sensitivity of LVEF worsening in detecting significant CAD is only 35%, the specificity is as high as 93%.

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. 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;30:1641–88.

    Article  PubMed  CAS  Google Scholar 

  2. Hashimoto J, Kubo A, Iwasaki R, Iwanaga S, Mitamura 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 

  3. Emmett L, Iwanochko RM, Freeman MR, Barolet A, Lee DS, Husain M. Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses. J Am Coll Cardiol 2002;39:991–8.

    Article  PubMed  Google Scholar 

  4. Yamagishi H, Shirai N, Yoshiyama M, Teragaki M, Akioka K, Takeuchi K, et al. Incremental value of left ventricular ejection fraction for detection of multivessel coronary artery disease in exercise (201)Tl gated myocardial perfusion imaging. J Nucl Med 2002;43:131–9.

    PubMed  Google Scholar 

  5. Shirai N, Yamagishi H, Yoshiyama M, Teragaki M, Akioka K, Takeuchi K, et al. Incremental value of assessment of regional wall Worsening of left ventricular ejection fraction motion for detection of multivessel coronary artery disease in exercise (201)Tl gated myocardial perfusion imaging. J Nucl Med 2002;43:443–50.

    PubMed  Google Scholar 

  6. Sharir T, Bacher-Stier C, Dhar S, Lewin HC, Miranda R, Friedman JD, et al. Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol 2000;86:1 171–5.

    Article  CAS  Google Scholar 

  7. Samady H, Wackers FJ, Joska TM, Zaret BL, Jain D. Pharmacologic stress perfusion imaging with adenosine: role of simultaneous low-level treadmill exercise. J Nucl Cardiol 2002;9:188–96.

    Article  PubMed  Google Scholar 

  8. 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 

  9. Druz RS, Akinboboye OA, Grimson R, Nichols KJ, Reichek N. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004; 11:534–41.

    Article  PubMed  Google Scholar 

  10. 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.

    PubMed  CAS  Google Scholar 

  11. Hung GU, Lee KW, Chen CP, Lin WY, Yang KT. Relationship of transient ischcmic dilation in dipyridamole myocardial perfusion imaging and stress-induced changes of functional parameters evaluated by Tl-201 gated SPECT. J Nucl Cardiol 2005;12:268–75.

    Article  PubMed  Google Scholar 

  12. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996;93:905–14.

    PubMed  CAS  Google Scholar 

  13. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535–43.

    PubMed  CAS  Google Scholar 

  14. Petix NR, Sestini S, Marcucci G, Coppola A, Arena A, Nassi F, et al. Can the reversible regional wall motion abnormalities on stress gated Tc-99m sestamibi SPECT predict a future cardiac event? J Nucl Cardiol 2005;12:20–31.

    Article  PubMed  Google Scholar 

  15. 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 

  16. Heiba SI, Santiago J, Mirzaitehrane M, Jana S, Dede F, Abdel-Dayem HM. Transient postischemic stunning evaluation by stress gated Tl-201 SPECT myocardial imaging: effect on systolic left ventricular function. J Nucl Cardiol 2002;9:482–90.

    Article  PubMed  Google Scholar 

  17. Santiago JF, Heiba SI, Jana S, Mirzaitehrane M, Dede F, Abdel-Dayem HM. Transient ischcmic stunning of the myocardium in stress thallium-201 gated SPET myocardial perfusion imaging: segmental analysis of myocardial perfusion, wall motion and wall thickening changes. Eur J Nucl Med Mol Imaging 2002;29:979–83.

    Article  PubMed  Google Scholar 

  18. Paul AK, Hasegawa S, Yoshioka J, Mu X, Maruyama K, Kusuoka H, et al. Characteristics of regional myocardial stunning after exercise in gated myocardial SPECT. J Nucl Cardiol 2002;9:388–94.

    Article  PubMed  Google Scholar 

  19. Berman D, Germano G, Lewin H, Kang X, Kavanagh PB, Tapnio P, et al. Comparison of post-stress ejection fraction and relative left ventricular volumes by automatic analysis of gated myocardial perfusion single-photon emission computed tomography acquired in the supine and prone positions. J Nucl Cardiol 1998;5:40–7.

    Article  PubMed  CAS  Google Scholar 

  20. Germano G, Kavanagh PB, Kavanagh JT, Wishner SH, Berman DS, Kavanagh GJ. Repeatability of automatic left ventricular cavity volume measurements from myocardial perfusion SPECT. J Nucl Cardiol 1998;5:477–83.

    Article  PubMed  CAS  Google Scholar 

  21. He ZX, Cwajg E, Preslar JS, Mahmarian JJ, Verani MS. 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 Cardiol 1999;6:412–77.

    Article  PubMed  CAS  Google Scholar 

  22. Daou D, Delahaye N, Vilain D, Lebtahi R, Faraggi M, Le GD. Identification of extensive coronary artery disease: incremental value of exercise Tl-201 SPECT to clinical and stress test variables. J Nucl Cardiol 2002;9:161–8.

    Article  PubMed  Google Scholar 

  23. Becker LC. Conditions for vasodilator-induced coronary steal in experimental myocardial ischemia. Circulation 1978;57:1103–10.

    PubMed  CAS  Google Scholar 

  24. Stolzenberg J, London R. Reliability of stress thallium-201 scanning in the clinical evaluation of coronary artery disease. Clin Nucl Med 1979;4:225–8.

    Article  PubMed  CAS  Google Scholar 

  25. 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 

  26. Ford PV, Chatziioannou SN, Moore WH, Dhekne RD. Overesti-mation of the LVEF by quantitative gated SPECT in simulated left ventricles. J Nucl Med 2001;42:454–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Changhua Christian Hospital, 135 Nan–Shiao St, 500, Changhua, Taiwan

    Guang-Uei Hung & Kung-Wei Lee

  2. Division of Cardiovascular Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan

    Ching-Pei Chen

  3. Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan

    Kuang-Tao Yang

  4. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Wan-Yu Lin

Authors
  1. Guang-Uei Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kung-Wei Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ching-Pei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuang-Tao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wan-Yu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hung, GU., Lee, KW., Chen, CP. et al. Worsening of left ventricular ejection fraction induced by dipyridamole on Tl-201 gated myocardial perfusion imaging predicts significant coronary artery disease. J Nucl Cardiol 13, 225–232 (2006). https://doi.org/10.1007/BF02971247

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02971247

Key Words

Search

Navigation