Left ventricular function at rest and during bicycle exercise in normal subjects: assessment by ECG-gated myocardial perfusion SPET with 99Tcm-tetrofosmin

Effect of sex, age, and weight on ejection fraction and end-systolic volume reference limits in gated myocardial perfusion SPECT

BACKGROUND

The left-ventricular ejection fraction (EF) and end-systolic volume (ESV) are strong predictors of prognosis for cardiac death. Gated myocardial perfusion single-photon emission computed tomography (gSPECT) may be used to measure ESV and EF. However, systematic differences may exist between referred populations. Our aim was to derive male and female reference limits for left-ventricular functional parameters, and determine the effect of age, weight, and body surface area (BSA).

METHODS AND RESULTS

The ejection fraction and ESV were derived using QGS software for 127 patients with normal gSPECT studies. The lower reference limits of EF were 46.2% and 55.6% for men and women, respectively. The upper reference limits of ESV were 30.4 mL and 21.4 mL, and 15.7 mL/m(2) and 11.1 mL/m(2), when indexed to BSA for men and women, respectively. There was no correlation between EF and age, weight, or BSA (P > .05). There was a small decrease in ESV with age, and an increase with weight and BSA (P < .05). The sex-specific differences remained after adjusting for confounding variables.

CONCLUSIONS

We demonstrated a significant sex difference for all functional parameters measured, and we established the influence of patient age and weight. Local reference limits for ESV and EF have been established, and the latter are transferable to other departments operating similar protocols.

Clinical Applications of ECG-gated Myocardial Perfusion SPECT

Erectrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) can be used to assess myocardial perfusion and left ventricular function simultaneously. Various clinical applications of gated SPECT and their usefulness have been reported. The functional variables that can be determined with gated SPECT have been limited to systolic indices. Therefore, we evaluated left ventricular diastolic function with gated SPECT using data obtained from various frames per cardiac cycle and found that date generated from 32-frames are suitable for clinical use. Serial assessment of left ventricular function was also performed during bicycle exercise and dobutamine stress by means of gated SPECT using short-time data collection. These techniques, therefore, have the potential to provide useful information for evaluating myocardial conditions, such as hibernation and residual ischemia in infarct areas. Recently, we have developed a new technique for three-dimensional registration of CT coronary angiography (CTCA) and ECG-gated myocardial perfusion SPECT. This technique of registration may assist the integration of information from gated SPECT and CTCA and may have clinical application for the diagnosis of ischemic heart disease. These various applications would contribute to the development of nuclear cardiology.

Serial assessment of left ventricular performance at rest and during bicycle exercise by ECG-gated myocardial perfusion SPECT

The present study evaluates left ventricular performance during exercise by ECG-gated myocardial perfusion SPECT with short-time data collection.

METHODS

The study population consisted of 10 healthy volunteers (Group N) and 9 patients with ischemic heart disease (Group I). Seven patients in Group I had a history of prior myocardial infarction. Rest ECG-gated SPECT was performed 40 min after an injection of Tc-99m-tetrofosmin (555-740 MBq). After resting data acquisition, Group N underwent up to two 5-min stages of exercise (75 and 125 watts) on a detachable bicycle ergometer. The Group I patients all underwent symptom-limited, maximal testing on the ergometer. ECG-gated SPECT data were acquired from both groups for 3 min at rest and during the last 3 min of each exercise stage.

RESULTS

Significant increases occurred in LVEF from rest to peak stress in both groups (from 55.4 +/- 5.8 to 66.6 +/- 4.1% in group N, p < 0.0001; from 49.0 +/- 12.8 to 56.7 +/- 13.8% in Group I, p < 0.001). The LVESV values significantly decreased to peak stress in Group N (from 49.9 +/- 13.1 to 37.8 +/- 10.0 ml, p < 0.0001), whereas LVEDV did not change (from 110.6 +/- 18.9 to 112.0 +/- 19.0 ml). In contrast, the LVESV values at rest and under peak stress were similar in Group I (from 52.6 +/- 23.9 to 51.7 +/- 31.4 ml) and LVEDV in Group I at peak exercise tended to increase (from 102.8 +/- 36.7 to 111.3 +/- 39.0 ml). The changes in LVESV from rest to peak stress were significantly different between Groups N and I (-12.1 +/- 6.3 vs. -0.9 +/- 11.6 ml, p < 0.02).

CONCLUSION

ECG-gated SPECT with short-time data collection can assess left ventricular function during exercise and may offer useful information for evaluating patients with ischemic heart disease.

Accuracy and reproducibility of left ventricular function from quantitative, gated, single photon emission computed tomography using dynamic myocardial phantoms: effect of pre-reconstruction filters

We have investigated the accuracy and reproducibility of left ventricular (LV) functions using quantitative, gated, single photon emission computed tomography (SPECT) software dependent on critical frequencies of pre-reconstruction filters. This study incorporated dynamic myocardial phantoms (myocardial and cone shapes). Gated SPECT of 8-interval sets were pre-filtered with Butterworth filters (critical frequency varying between 0.16 and 1.16 cycles/cm, order 5) and with no filter. Phantoms were repositioned, and SPECT acquisitions were repeated. As the critical frequency increased, the estimated LV volume increased to reach a plateau at the level of the critical frequency, 0.54 cycles/cm. Conversely, the values of ejection fractions, wall motion and wall thickening with different filters which used critical frequency of > or =0.39 cycles/cm remained unchanged. However, LV functions and volumes were underestimated when any pre-reconstruction filter was used. Standard deviations of LV functions after repeated measurements were unaffected by different filters with critical frequencies of > or =0.39 cycles/cm. Standard deviations of LV volume, ejection fraction, wall motion and wall thickening were <2.2 ml, <0.9%, <0.6 mm and <8.7%, respectively. Therefore, with the exception of low critical frequencies, LV functions and volumes were highly reproducible when these routine reconstruction filters were used.

Simultaneous assessment of Tc-99m-sestamibi and I-123-BMIPP myocardial distribution in patients with myocardial infarction: evaluation of left ventricular function with ECG-gated myocardial SPECT

123I-labeled 15-(p-iodophenyl)-3R,S-methyl pentadecanoic acid (BMIPP) is a branched-chain free fatty acid that is used to evaluate various cardiac diseases. The aim of the present study was to investigate the relationship between myocardial perfusion (99mTc-sestamibi) and BMIPP uptake, and to correlate perfusion and metabolic alterations with regional left ventricular dysfunction in patients with myocardial infarction (MI). ECG-gated dual-isotope myocardial SPECT was performed on 130 patients with MI with sestamibi (555 MBq) and BMIPP (148 MBq). The patients were classified into 3 groups according to PTCA therapy and the interval between the onset of infarction and RI injection (OR time). Group A (n = 56) included patients whose OR time was less than one month and who had undergone successful PTCA, Group B (n = 36) had OR times of less than one month and had conservative medical therapy, and Group C (n = 38) had OR times of over one month. The severity scores of the dual-isotope images were calculated from the defect scores in 9 segments. From the ECG-gated SPECT data with sestamibi, the left ventricular ejection fraction (LVEF; %) and regional wall motion were determined automatically using the QGS program LVEF obtained from gated SPECT correlated well with the severity scores for sestamibi and BMIPP (r = -0.68 and -0.76, respectively). The delta severity scores (BMIPP scores - sestamibi scores) of Group A were significantly higher than those of the other two groups (3.6 +/- 3.0 vs. 1.5 +/- 1.7 and 1.0 +/- 1.4, p < 0.001 ). The rate of dysfunctional segments with normal sestamihi distribution was significantly higher in Group A than in Group C (20.7% vs. 6.7%, p < 0.001). ECG-gated dual-isotope SPECT is useful since myocardial perfusion, fatty acid metabolism and left ventricular function can be analyzed during a single examination, so that this procedure has the potential to provide comprehensive information when evaluating patients with ischemic heart disease.