Comparing two simultaneously acquired studies, the use of 16 instead of 8 frames has minor and predictable influence on functional data. Furthermore, there are no differences in the detection of stress-induced functional changes. The advantage of 16 over 8 frames in the daily clinical practice appears questionable.

Background. Because of persistent stunning, post-treatment functional abnormalities could identify the initial risk area. The study aims to detect myocardial salvage using postrevascularization gated SPECT in acute myocardial infarction (AMI) treated by reperfusion therapy.Methods. In 36 AMI patients, we performed a first gated SPECT injecting 99mTc-sestamibi before primary percutaneous coronary intervention (PCI), and a second 5 days later. The salvage index defined by the two perfusion images was compared with the value obtained by subtracting in the second gated SPECT the extent of perfusion defect from the extent of wall thickening abnormalities.Results. The wall thickening salvage index correlated with the reference perfusion salvage index (Spearman's q 5 .92, P < .0001), with a 95% limit of agreement 5 ±.25. The agreement between the classifications in salvage index tertiles of the reference and of the wall thickening salvage index was good (kappa 5 .75). All patients with optimal PCI result and 18/24 of those with intermediate or poor outcome were correctly classified.Conclusions. Comparing function and perfusion in a single post-PCI 99m Tc-sestamibi gated SPECT it is possible to estimate myocardial salvage. This could have useful implications in studies comparing different treatment strategies for AMI. (J Nucl Cardiol 2010;17:825-30.)

Purpose The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. Methods We prospectively enrolled 57 consecutive patients with post-stress EF drop ≥5 EF units and summed difference score (SDS)≤1. They were followed up for more than 1 year and their outcome was compared with a group of sex-and agematched controls with the same SDS but without EF decrease. Results During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p<0.0001) between the event-free survival curves of the two groups. ConclusionThe event rate of patients with post-stress EF decrease≥5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted.

Background. Gated single photon emission computed tomography (SPECT) identifies functional changes produced by ischemia, but the influence of acquisition delay on their detection is not established.Methods and Results. In 80 patients with known or suspected coronary artery disease, gated SPECT was acquired twice: first, less than 30 minutes after peak exercise (stress 1), and second, more than 45 minutes after peak exercise (stress 2). End-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were compared with perfusion. The relationship between the ⌬EF (stress EF ؊ resting EF) and the summed difference score (SDS) was ؊0.443 (P < .0001) for stress 1 and ؊0.416 (P < .0001) for stress 2. In stress 1, EF increased in patients without inducible ischemia (SDS ‫؍‬ 0) (57% ؎ 10% vs 54% ؎ 9% at rest, P < .02) and decreased in those with an SDS of 1 or greater (53% ؎ 10.8% vs 55% ؎ 9.6% at rest, P < .05). In stress 2, EF was unchanged in patients without ischemia (55.8% ؎ 9.7%, P ‫؍‬ .06) and decreased in the other patients (52.8% ؎ 10.2%, P < .01). In patients without ischemia, both the EDV and ESV decreased significantly in stress 1 and were unchanged in stress 2. In patients with an SDS of 1 or greater, the EDV remained unchanged and the ESV minimally decreased in stress 1, whereas both volumes clearly and significantly increased in stress 2.

FDG-positron emission tomography (PET) performed early during therapy in advanced Hodgkin lymphoma patients has been confirmed as being important for progression-free survival. A group of patients with a negative interim-PET (i-PET) showed a positive end induction PET (e-PET). The aim of this study was to evaluate the clinical characteristics of patients with a positive e-PET as a secondary end point of the HD0801 study. A total of 519 patients with advanced-stage de novo Hodgkin lymphoma received initial treatment and underwent an i-PET. Patients with negative results continued the standard treatment. i-PET negative patients were then evaluated for response with an e-PET and those patients found to have a positive one were also then given a salvage therapy. Among 409 i-PET negative, 16 interrupted the therapy, 393 patients were evaluated with an e-PET, and 39 were positive. Sixteen out of 39 underwent a diagnostic biopsy and 15 were confirmed as HD. Seventeen out of 39 e-PET were reviewed according to the Deauville Score and, in sixteen, it was confirmed positive (10 DS 5, 6 DS 4). With the exception of high LDH value at diagnosis (p = 0.01; HR 95% CI 1.18-4.89), no clinical characteristics were significantly different in comparison with e-PET negative patients. Positive e-PET after a negative i-PET has a worse outcome when compared with i-PET positive patients salvaged with therapy intensification. It was not possible to identify clinical characteristics associated with a positive e-PET.