Equilibrium radionuclide angiography: Present and future

Abstract

This editorial refers to the article published by Sachpekidis et al 1 titled 'Equilibrium radionuclide angiography (ERNA): intra-and interobserver repeatability and reproducibility in the assessment of cardiac systolic and diastolic function' on the Journal of Nuclear Cardiology. The objective of this study was to assess the intra-and interobserver agreement in assessing the systolic and diastolic function with ERNA. The authors analyzed thirty-two adults underwent baseline and repeat ERNA. An experienced and a trainee operator analyzed the data by assigning regions of interest manually, fully automatically, and semi-automatically. The Bland-Altman statistic was used to assess the repeatability (two different assessments of a single acquisition) and reproducibility (assessments of two different acquisitions). According to the obtained results, the Authors concluded that: 'A good repeatability but a moderate reproducibility was found in the assessment of the left ventricular ejection fraction (LVEF). Less good were the findings in the assessment of diastolic function. The results also depended on the software tool'.This article provides interesting information about the intra-and interobserver repeatability and reproducibility in the assessment of cardiac systolic and diastolic function. Despite the fact that in the conclusions of this study the authors say that ERNA has a moderate reproducibility in the assessment of the LVEF; ERNA continues to be one of the best imaging techniques for the analysis of ventricular function. The analysis of the variability in the measurements of a technique is complex and not only depends on of the intra-and interobserver variability, but of other variabilities that are not generally taken into account, such as the day-to-day variability of the phenomenon studied, the variability of the pathology, age, gender, etc. In addition to this research study, it has a very heterogeneous population (men = 20, women = 12, heart failure = 13, cardiotoxic chemotherapy = 12, different degree of systolic dysfunction) in a small (n = 31) number of patients. Table 1 shows the reproducibility, and inter-and intra-observer variations of ERNA according to different acquisition methodology to evaluate left and right ventricular function. 1-7 ERNA has a high reproducibility, very low inter-or intra-observer variability, and high precision; it has been shown to be accurate when compared to other modalities and has strong early data that demonstrated efficacy in guiding the safety of treatment regimens, and it continues to be widely used for routine clinical monitoring. 8 This information is consistent with the comments of Sachpekidis et al. 9 in a previous review. Haarmark et al 10 evaluated 463 subjects without diabetes, previous potentially cardiotoxic chemotherapy, known cardiovascular or pulmonary disease, by means of Cadmium Zinc Telluride (CZT) SPECT camera. They conclude that there are age-related changes in cardiac dimensions with age depending on gender, although with only

Low-dose dobutamine stress gated blood pool SPECT assessment of left ventricular contractile reserve in ischemic cardiomyopathy: a feasibility study

“…Previous studies have demonstrated an excellent reproducibility of the LVEF and volumes obtained with GBPS at rest [19,20]. SPECT ERNA is a very good tool for the assessment of LV dyssynchrony.…”

“…GBPS is a widely used imaging technique for assessment of myocardial contractility. This approach has diagnostic and prognostic signi cance in patients with HF including those with arrhythmia (particularly in CRT candidates) [25], pulmonary embolism [26] and cardiotoxicity [17,20,27]. This method was validated on cardiac phantom [28] and showed good correlation with CMR [29] and TTE [25].…”

Cardiac CZT-SPECT: More than left ventricular imaging

“…Another feature with the CZT-ERNA technique that has been demonstrated by others and once again confirmed by Apert et al in the study in this issue is the low variability of cardiac measurements. 11 This high reproducibility extends to other variables than RVEF/LVEF such as peak emptying and filling rates (PER and PFR, respectively) for both left and right ventricles as well as time to peak filling rate (TTPFR). Moreover reference ERNA data for CZT-SPECT in chemotherapy naïve cancer patients have been published for both LVEF and RVEF along with ventricular volumes, PER, PFR and TTPFR.…”

Shining Damaged Hearts: Immunotherapy-Related Cardiotoxicity in the Spotlight of Nuclear Cardiology

“…ERNA shows high precision and repeatability [ 154 , 155 ] and fewer variations depending on external circumstances than echocardiography (e.g., observer-dependent factors or quality of echogenic window) [ 131 ]. Moreover, the imaging technique is well established and widely available.…”