How variable are the volumetric measurements from gated perfusion SPECT when a one-day stress-rest protocol is used?

Camm, Christian Fielder; Emery, Alexander; Rose-Innes, Elizabeth; Pavlitchouk, Sergei; Sabharwal, Nikant; Kelion, Andrew

doi:10.1007/s12350-018-1253-4

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…Transient ischemic dilatation (TID) is a well-known phenomenon in myocardial perfusion single photon emission computed tomography (SPECT) (MPS), often associated with left ventricular (LV) ischemic functional claudication at stress or with diffuse subendocardial ischemia, representing a parameter with additional prognostic value using a variety of protocols and stressors [1][2][3][4][5]. TID has also been confirmed as a high risk finding using stress echocardiography [6,7].…”

Section: Introductionmentioning

confidence: 99%

Relationship between transient ischemic dilatation and changes in heart rate during gated SPECT acquisition in a low-risk population without perfusion defects

Mut,

Gaudiano,

Kapitán

2024

Nuclear Medicine Communications

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Objectives Transient ischemic dilatation (TID) in myocardial perfusion single photon emission computed tomography (SPECT) is considered a marker of poor prognosis. However, it has been suggested that some cases are due to apparent volumetric changes secondary to differences in heart rate (HR) at the time of acquisition. We assessed the correlation between transient dilatation and HR in low risk patients with no perfusion defects. Methods We retrospectively analyzed patients sent for 99mTc-MIBI SPECT using a 2-day protocol. We recorded the median HR during acquisition and the HR difference (HRD) between the rest and post-stress. We obtained the medium ventricular volume, end-diastolic volume (EDV), and end-systolic volume (ESV). We included patients in which TID using medium ventricular volume (TIDMV) was ≥1.2. TID was also calculated for the EDV and ESV (TIDEDV, TIDESV). We excluded patients with known coronary artery disease, perfusion defects, various ECG disorders, positive stress test, or ESV < 10 ml. Results From a total of 2006 patients, 63 (50 exercise, 13 dipyridamole) met the criteria for analysis (age 63.8 ± 9.7, 44 men). TIDMV was 1.29 ± 0.09 and HRD 9.8 beats per minute (BPM) (range −10 to 41). There was positive correlation between HRD and TIDMV (r = 0.51, P < 0.001) and TIDEDV (r = 0.5, P < 0.001), but not TIDESV (r = 0.23, P = 0.07). Correlation was stronger when HRD was ≥10 BPM (r = 0.67, P < 0.001). Conclusion TID without perfusion defects should be interpreted with caution in the presence of HRD ≥ 10 BPM during post-stress acquisition.

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Section: Introductionmentioning

confidence: 99%

Relationship between transient ischemic dilatation and changes in heart rate during gated SPECT acquisition in a low-risk population without perfusion defects

Mut,

Gaudiano,

Kapitán

2024

Nuclear Medicine Communications

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“…In the current issue of the Journal of Nuclear Cardiology, Camm et al 17 address some of these challenges in a large retrospective study. The variation in TID and LVEF decrease from rest to stress was analyzed in a-rather normal-population including 661 gated and 992 ungated patient studies without inducible perfusion defects.…”

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Do we really need to look at volumetric measurements with 99mTc single photon emission computed tomography (SPECT) myocardial perfusion imaging?

Benz

Giannopoulos

2019

Journal of Nuclear Cardiology

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A little less than a century ago, in their classical work, Tennant and Wiggers 1 observed in open-chest dogs that within 60 seconds of coronary occlusion myocardial contractions in the ischemic zone change from active shortening to passive systolic lengthening. After restoration of myocardial blood flow, contractile dysfunction was reversed. In later animal work, Heyndrickx and colleagues 2 demonstrated that while regional electrocardiograms normalize within seconds, contractile dysfunction lasts for up to 2 hours after a 5-minute occlusion and for up to 24 hours after a 15-minute occlusion. The functional effects in the ischemic myocardium were shown to persist longer than one could have been predicted by the rapid normalization of coronary flow. The concept of myocardial stunning was born-and defined as a state of prolonged contractile dysfunction of post-ischemic myocardium in which myocardial function is gradually restored over time.Post-ischemic stunning can be quantified on single photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI) from regional wall motion abnormalities or more globally as a reduction in left ventricular ejection fraction (LVEF).Another marker for myocardial stunning is the increase in LV volumes after stress, namely transient ischemic dilatation (TID) that is considered indicative of severe and extensive coronary artery disease and a poor prognostic sign.3,4 These parameters have been investigated by a staggering number of studies and their added diagnostic and prognostic value is undisputed. 5-8Reliable assessment and quantification of myocardial stunning by SPECT-MPI pose however a series of challenges on the applied imaging protocols. First, the timing of the image acquisition is key. The time elapsed between stress testing and image acquisition determines the severity of post-stress LVEF decrease. Further, if the delay between stress and rest image acquisition is too short to allow for recovery of myocardial contractility, the post-stress EF decrease may be underestimated.10 Second, the type of stress agent may influence the severity of stress. Although the initial investigations on TID were performed by physical stress, 4 more recent studies have confirmed these results by vasodilator stress.7 Last but not least, measurement of LVEF and LV volumes might be limited by SPECT-MPI given its spatial resolution. The pathophysiological mechanism of these phenomena is also a highly debated subject. Some authors see it as true increase in LV volume due to post-ischemic stunning and offer several potential mechanisms for the increased contractility (i.e., enhanced venous return via Frank-Starling, increased myocardial blood flow via Gregg mechanism and/or by higher heart rate). 11,12 Others explain it by a stress-induced subendocardial hypoperfusion giving the visual impression of dilatation on ungated SPECT. 13,14 Nonetheless, the severity of post-ischemic stunning differs between the different stress agents: it seems that myocardial dysfunction persists much longe...

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How variable are the volumetric measurements from gated perfusion SPECT when a one-day stress-rest protocol is used?

Abstract: Using a one-day stress-rest Tc-tetrofosmin protocol, a fall in LV EF between rest and stress of> 11.6% or a TID ratio of > 1.23 is likely to be clinically reliable. The upper limit of normal for TID ratio needs to be increased for patients with small LV chamber volumes.

Cited by 2 publications

References 27 publications

Relationship between transient ischemic dilatation and changes in heart rate during gated SPECT acquisition in a low-risk population without perfusion defects

Relationship between transient ischemic dilatation and changes in heart rate during gated SPECT acquisition in a low-risk population without perfusion defects

Do we really need to look at volumetric measurements with 99mTc single photon emission computed tomography (SPECT) myocardial perfusion imaging?

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