Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated 82rubidium myocardial perfusion PET

Brown, Tracy L.; Merrill, Jennifer; Volokh, Lana; Bengel, Frank M.

doi:10.1007/s00259-007-0603-2

Cited by 46 publications

(26 citation statements)

References 26 publications

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“…The dipyridamole-induced change of the LVEF is considered a marker of the severity of ischemia and extent of flow-limiting disease (12,13). The change was explained by an increase in EDV and mild decrease in ESV during vasodilator stress in our healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

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Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Bravo¹,

Chien²,

Javadi³

et al. 2010

J Nucl Med

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Electrocardiographic gating is increasingly used for 82 Rb cardiac PET/CT, but reference ranges for global functional parameters are not well defined. We sought to establish reference values for left ventricular ejection fraction (LVEF), end systolic volume (ESV), and end diastolic volume (EDV) using 4 different commercial software packages. Additionally, we compared 2 different approaches for the definition of a healthy individual. Methods: Sixty-two subjects (mean age 6 SD, 49 6 9 y; 85% women; mean body mass index 6 SD, 34 6 10 kg/m 2 ) who underwent 82 Rb-gated myocardial perfusion PET/CT were evaluated. All subjects had normal myocardial perfusion and no history of coronary artery disease (CAD) or cardiomyopathy. Subgroup 1 consisted of 34 individuals with low pretest probability of CAD (,10%), and subgroup 2 comprised 28 subjects who had no atherosclerosis on a coronary CT angiogram obtained concurrently during the PET/CT session. LVEF, ESV, and EDV were calculated at rest and during dipyridamole-induced stress, using CardIQ Physio (a dedicated PET software) and the 3 major SPECT software packages (Emory Cardiac Toolbox, Quantitative Gated SPECT, and 4DM-SPECT). Results: Mean LVEF was significantly different among all 4 software packages. LVEF was most comparable between CardIQ Physio (62% 6 6% and 54% 6 7% at stress and rest, respectively) and 4DM-SPECT (64% 6 7% and 56% 6 8%, respectively), whereas Emory Cardiac Toolbox yielded higher values (71% 6 6% and 65% 6 6%, respectively, P , 0.001) and Quantitated Gated SPECT lower values (56% 6 8% and 50% 6 8%, respectively, P , 0.001). Subgroup 1 (low likelihood) demonstrated higher LVEF values than did subgroup 2 (normal CT angiography findings), using all software packages (P , 0.05). However, mean ESV and EDV at stress and rest were comparable between both subgroups (p 5 NS). Intra-and interobserver agreement were excellent for all methods. Conclusion: The reference range of LVEF and LV volumes from gated 82 Rb PET/CT varies significantly among available software programs and therefore cannot be used interchangeably. LVEF results were higher when healthy subjects were defined by a low pretest probability of CAD than by normal CT angiography results.

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Section: Discussionmentioning

confidence: 99%

“…The rest and stress PET data were checked for accurate alignment with the low-dose CT scan, and softwarebased realignment was performed for attenuation correction if necessary (19). List-mode data were resampled to static (90-s prescan delay) and gated (8 bins per cardiac cycle) images (13).…”

Section: Acquisition Protocolmentioning

confidence: 99%

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Bravo¹,

Chien²,

Javadi³

et al. 2010

J Nucl Med

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“…It was already known that functional changes may be observed and have diagnostic value in the setting of vasodilator stress as well as after exercise [4,5]. Furthermore, recent data based on the EF calculated using gated PET after adenosine or dipyridamole infusion support the concept that abnormalities in stressinduced functional response may play an important diagnostic role even in the instance of vasodilator stimulation [19,20]. These observations suggest that in the patients with EF drop true diffuse ischaemia without regional perfusion inhomogeneities could occur, leading to transient functional impairment.…”

Section: Mechanisms Of Ef Decreasementioning

confidence: 99%

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Dona

Massi

Settimo

et al. 2010

Eur J Nucl Med Mol Imaging

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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.

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“…82 Rb PET images have fewer counts because of the ultrashort half-life of the tracer, and they have lower spatial resolution because of the high positron energy of 82 Rb. Some recent studies have suggested that the functional response to vasodilator stress can be identified with rest-stress 82 Rb PET as an additional diagnostic parameter in the assessment of coronary artery disease (CAD) (11,12), but those studies using gated 82 Rb PET did not include independent functional reference techniques.…”

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Comparison of Measures of Left Ventricular Function from Electrocardiographically Gated ⁸²Rb PET with Contrast-Enhanced CT Ventriculography: A Hybrid PET/CT Analysis

Chander¹,

Brenner

Lautamäki

et al. 2008

J Nucl Med

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Because of the ultrashort tracer half-life and high positron energy of 82 Rb, PET images acquired with this tracer are noisier and of lower resolution than those obtained with other PET tracers. The validity of electrocardiographic gating using 82 Rb for assessment of left ventricular (LV) function is not well established. To support feasibility, we compared functional parameters from gated 82 Rb PET with simultaneous high-resolution contrastenhanced CT ventriculography, obtained as a byproduct a CT coronary angiography during hybrid cardiac PET/CT. Methods: A total of 24 patients underwent PET/CT, consisting of rest and dipyridamole 82 Rb perfusion studies and contrast-enhanced CT angiography, using a 64-slice scanner, for the workup of coronary artery disease. From gated PET images, LV ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) were calculated using 2 commercial products. For functional CT analysis, commercial software using endocardial contour detection was applied. Results: Inter-and intraobserver agreement was good for all methods. On CT, EF was 66% 6 13%, ESV was 41 6 29 mL, and EDV was 115 6 36 mL. On PET, EF during dipyridamole was 56% 6 15% and 52% 6 15% using the 2 commercial products (P , 0.05 vs. CT), ESV was 36 6 28 and 47 6 35 mL (P 5 not significant vs. CT), and EDV was 75 6 30 and 91 6 33 mL (P , 0.05 vs. CT). Correlations with CT were 0.85 and 0.87 for EF using commercial software, 0.76 and 0.88 for ESV, and 0.60 and 0.68 for EDV (P , 0.01 for all). Bland-Altman analysis confirmed systematic underestimation of EF and EDV by PET versus CT but did not show a significant deviation from linearity. Conclusion: Global LV function can be measured reproducibly from gated 82 Rb PET, using different available software products. However, underestimation of EF by 82 Rb PET, compared with CT ventriculography, is present, which is a result of underestimation of EDV from countpoor ED frames. This underestimation needs to be considered for clinical interpretation of 82 Rb PET.

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Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated 82rubidium myocardial perfusion PET

Cited by 46 publications

References 26 publications

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Comparison of Measures of Left Ventricular Function from Electrocardiographically Gated ⁸²Rb PET with Contrast-Enhanced CT Ventriculography: A Hybrid PET/CT Analysis

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Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated 82rubidium myocardial perfusion PET

Cited by 46 publications

References 26 publications

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated 82Rb Cardiac PET/CT Using Commercially Available Software

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated 82Rb Cardiac PET/CT Using Commercially Available Software

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

Comparison of Measures of Left Ventricular Function from Electrocardiographically Gated 82Rb PET with Contrast-Enhanced CT Ventriculography: A Hybrid PET/CT Analysis

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Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated ⁸²Rb Cardiac PET/CT Using Commercially Available Software

Comparison of Measures of Left Ventricular Function from Electrocardiographically Gated ⁸²Rb PET with Contrast-Enhanced CT Ventriculography: A Hybrid PET/CT Analysis