Regional wall-motion abnormalities on post-stress electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomography imaging predict cardiac events

Kapetanopoulos, Athanasios; Ahlberg, Alan W.; Taub, Cynthia C.; Katten, Deborah; Heller, Gary V.

doi:10.1016/j.nuclcard.2007.07.014

Cited by 18 publications

(9 citation statements)

References 17 publications

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“…This suggests that the 12-lead ECG provides insufficient information for satisfactory diagnosis of ischemia. Other non-invasive techniques, including radionuclide methods [9], magnetic resonance imaging [10] and positron computed tomography [11], are far more sensitive to the detection of ischemia. However, they are highly expensive and time consuming, and therefore not practical for day-to-day, bedside monitoring and detection of silent ischemia (i.e.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Electric- and Magnetic-Cardiograms Produced by Myocardial Ischemia in Models of the Human Ventricle and Torso

Alday

Zhang

et al. 2016

PLoS ONE

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Myocardial ventricular ischemia arises from a lack of blood supply to the heart, which may cause abnormal repolarization and excitation wave conduction patterns in the tissue, leading to cardiac arrhythmias and even sudden death. Current diagnosis of cardiac ischemia by the 12-lead electrocardiogram (ECG) has limitations as they are insensitive in many cases and may show unnoticeable differences to normal patterns. As the magnetic field provides extra information on cardiac excitation and is more sensitive to tangential currents to the surface of the chest, whereas the electric field is more sensitive to flux currents, it has been hypothesized that the magnetocardiogram (MCG) may provide a complementary method to the ECG in ischemic diagnosis. However, it is unclear yet about the differences in sensitivity regions of body surface ECG and MCG signals to ischemic conditions. The aim of this study was to investigate such differences by using 12-, 36- ECG and 36-MCG computed from multi-scale biophysically detailed computational models of the human ventricles and torso in both control and ischemic conditions. It was shown that ischemia produced changes in the ECG and MCG signals in the QRS complex, T-wave and ST-segment, with greater relative differences seen in the 36-lead ECG and MCG as compared to the 12-leads ECG (34% and 37% vs 26%, respectively). The 36-lead ECG showed more averaged sensitivity than the MCG in the change of T-wave due to ischemia (37% vs 32%, respectively), whereas the MCG showed greater sensitivity than the ECG in the change of the ST-segment (50% vs 40%, respectively). In addition, both MCG and ECG showed regional-dependent changes to ischemia, but with MCG showing a stronger correlation between ischemic region in the heart. In conclusion, MCG shows more sensitivity than ECG in response to ischemia, which may provide an alternative method for the diagnosis of ischemia.

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Section: Introductionmentioning

confidence: 99%

Comparison of Electric- and Magnetic-Cardiograms Produced by Myocardial Ischemia in Models of the Human Ventricle and Torso

Alday

Zhang

et al. 2016

PLoS ONE

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“…In addi- tion, gated myocardial SPECT has been reported to be useful for the evaluation of EDV, ESV, LVEF, stroke volume/cardiac index, myocardial wall motion, and changes in myocardial wall thickness, which are critical in risk and prognosis assessment in coronary artery diseases (1,2) Published reports have stated that application of the exercise or drug-loading method by using gated myocardial SPECT can quantitatively evaluate markers of poor prognosis, transient reduction in LVEF after loading, and myocardial wall motion abnormality (3,4). These reports suggest the need of further improvement of the technical accuracy of nuclear cardiology examinations.…”

Section: Discussionmentioning

confidence: 99%

Development of a 2-Layer Double-Pump Dynamic Cardiac Phantom

Hara

Onoguchi

Osamu

et al. 2016

J. Nucl. Med. Technol.

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The conventional dynamic cardiac phantom used in the field of nuclear medicine has a structure for which the size of the external side of the heart (the outer membrane substituting the myocardial layer) is fixed and only the inner side (the inner membrane substituting the ventricle part) moves anteroposteriorly. Therefore, its usefulness in technical evaluation is limited. Hence, we developed a new dynamic cardiac phantom in which the outer and inner membranes freely move. Methods: Using a SPECT/CT system, we performed validation by filling the myocardial layer of the dynamic cardiac phantom with solution and the ventricle part with contrast medium. We evaluated myocardial wall motions of 3 segments (basal, mid, and apical) by setting the stroke ratios at 20:20 and 10:10 (ventricle-to-myocardial layer ratio). Results: The myocardial wall motions (mean ± SD) at the stroke ratio of 20:20 were 7.50 ± 0.44, 11.15 ± 0.56, and 9.90 ± 0.24 mm in the basal, mid, and apical segments, respectively. The wall motions (mean ± SD) at the stroke ratio of 10:10 were 3.82 ± 0.43, 5.63 ± 0.39, and 4.53 ± 0.10 mm, respectively. Conclusion: In our dynamic cardiac phantom, different movements could be induced in the myocardial wall by freely changing the stroke ratio. These results suggest that the use of this phantom can realize technical evaluation that presumes various clinical conditions.

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“…2,3 However, accurate regional assessment of contractile function is also of great importance, since it could enhance the detection of CAD, 4 and provide additional prognostic information in predicting cardiac events. 5,6 Similar to myocardial perfusion, regional motion and thickening can be assessed using semi-quantitative visual methods, based on segmental scoring. While motion score simply reflects the extent of inward shift of the ventricular wall, thickening is assessed as systolic brightening of the myocardium occurring due to the partial volume effect.…”

Section: See Related Article Pp 742-753mentioning

confidence: 99%

“…5,6 Similar to myocardial perfusion, regional motion and thickening can be assessed using semi-quantitative visual methods, based on segmental scoring. While motion score simply reflects the extent of inward shift of the ventricular wall, thickening is assessed as systolic brightening of the myocardium occurring due to the partial volume effect.…”

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confidence: 99%

What is the value of motion and thickening in gated myocardial perfusion SPECT?

Sharir

2018

Journal of Nuclear Cardiology

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Myocardial perfusion SPECT imaging (MPI) is a stress imaging modality, widely used in the detection and evaluation of coronary artery disease (CAD). This method is unique in providing simultaneous bi-modal functional imaging of relative myocardial perfusion and left ventricular (LV) function.1 While perfusion images identify regions with relative hypoperfusion, gated SPECT allows assessment of global and regional LV function. The added prognostic information gained by global LV function to myocardial perfusion findings has been extensively shown.2,3 However, accurate regional assessment of contractile function is also of great importance, since it could enhance the detection of CAD, 4 and provide additional prognostic information in predicting cardiac events. 5,6 Similar to myocardial perfusion, regional motion and thickening can be assessed using semi-quantitative visual methods, based on segmental scoring. While motion score simply reflects the extent of inward shift of the ventricular wall, thickening is assessed as systolic brightening of the myocardium occurring due to the partial volume effect. This systolic apparent increase in count density occurs since myocardial thickness is commonly in the range up to 2 cm, less than twice the full width at half maximum of the point spread function of conventional gamma cameras with intrinsic spatial resolution of *1 cm.7 Visual assessment of regional LV contractile function is expert dependent, and suffers from limited reproducibility with high inter-and intraobserver variability. 8 Therefore, several methods have been developed and validated, which automatically quantify motion and thickening, and provide useful and reproducible assessment of regional function.9,10 Whether visually or automatically assessed, regional motion and thickening have been shown as important adjunctive parameters to perfusion in the diagnosis of CAD.In the current issue of the Journal of Nuclear Cardiology, Yang et al. used resting gated SPECT MPI to demonstrate the relationship between myocardial thickening and LV remodeling among patients with history of myocardial infarction (MI). The 92 patients included in the analysis were divided into subacute MI (3-6 months before nuclear testing, n = 54) and old MI ([6 months before nuclear testing, n = 38) subgroups. In addition, all patients underwent FDG-PET imaging to identify myocardial viability as metabolic perfusion mismatch, and a scar score was calculated. LV remodeling was defined as end-diastolic volume index [62.53 ml/m 2 , derived as mean value ?2 standard deviations from gated SPECT of another 95 patients who had normal SPECT MPI and no evidence of CAD. Compared to patients with subacute MI, those with old MI had larger LV volume and worse cardiac function, larger perfusion deficit, and higher summed thickening score (STS). Interestingly, of all the demographic, clinical, perfusion, and metabolic imaging parameters evaluated, only the STS and the % of segments with reduced thickening among segments with normal perfusion were independ...

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Regional wall-motion abnormalities on post-stress electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomography imaging predict cardiac events

Abstract: Regional LV function data from gated SPECT provide important prognostic information, and may identify a subgroup of patients with preserved EF and ischemia who are at significant risk for future cardiac events.

Cited by 18 publications

References 17 publications

Comparison of Electric- and Magnetic-Cardiograms Produced by Myocardial Ischemia in Models of the Human Ventricle and Torso

Comparison of Electric- and Magnetic-Cardiograms Produced by Myocardial Ischemia in Models of the Human Ventricle and Torso

Development of a 2-Layer Double-Pump Dynamic Cardiac Phantom

What is the value of motion and thickening in gated myocardial perfusion SPECT?

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