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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-03-2011 | Original Article

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

Authors: Manjola Dona, Lucia Massi, Leonardo Settimo, Matteo Bartolini, Gianluca Giannì, Alberto Pupi, Roberto Sciagrà

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2011

Abstract

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 age-matched 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.

Conclusion

The 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.

Johnson LL, Verdesca SA, Aude WY, Xavier RC, Nott LT, Campanella MW, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997;30:1641–8.CrossRefPubMed

Hurwitz GA, Ghali SK, Husni M, Slomka PJ, Mattar AG, Reid RH, et al. Pulmonary uptake of technetium-99m-sestamibi induced by dipyridamole-based stress or exercise. J Nucl Med 1998;39:339–45.PubMed

Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of lung sestamibi uptake in myocardial perfusion imaging of patients with known or suspected coronary artery disease. J Am Coll Cardiol 2005;45:1676–82.CrossRefPubMed

Druz RS, Akinboboye OA, Grimson R, Nichols KJ, Reichek N. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004;11:534–41.CrossRefPubMed

Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, et al. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med 2004;45:1999–2007.PubMed

Hida S, Chikamori T, Tanaka H, Usui Y, Igarashi Y, Nagao T, et al. Diagnostic value of left ventricular function after stress and at rest in the detection of multivessel coronary artery disease as assessed by electrocardiogram-gated SPECT. J Nucl Cardiol 2007;14:68–74.CrossRefPubMed

Ramakrishna G, Miller TD, Hodge DO, O’Connor MK, Gibbons RJ. Differences in left ventricular ejection fraction and volumes measured at rest and poststress by gated sestamibi SPECT. J Nucl Cardiol 2006;13:668–74.CrossRefPubMed

Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging. J Nucl Med 2005;46:204–11.PubMed

Sharir T, Germano G, Waechter PB, Kavanagh PB, Areeda JS, Gerlach J, et al. A new algorithm for the quantitation of myocardial perfusion SPECT. II: validation and diagnostic yield. J Nucl Med 2000;41:720–7.PubMed

10.

Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–47.PubMed

11.

Groutars RG, Verzijlbergen JF, Muller AJ, Ascoop CA, Tiel-van Buul MM, Zwinderman AH, et al. Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT. J Nucl Cardiol 2000;7:333–41.CrossRefPubMed

12.

Galassi AR, Azzarelli S, Tomaselli A, Giosofatto R, Ragusa A, Musumeci S, et al. Incremental prognostic value of technetium-99m-tetrofosmin exercise myocardial perfusion imaging for predicting outcomes in patients with suspected or known coronary artery disease. Am J Cardiol 2001;88:101–6.CrossRefPubMed

13.

Elhendy A, Schinkel A, Bax JJ, van Domburg RT, Poldermans D. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol 2003;10:261–6.CrossRefPubMed

14.

Zhang X, Liu X, He ZX, Shi R, Yang M, Gao R, et al. Long-term prognostic value of exercise 99mTc-MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 2004;31:655–62.CrossRefPubMed

15.

Yang MF, Dou KF, Liu XJ, Yang YJ, He ZX. Prognostic value of normal exercise 99mTc-sestamibi myocardial tomography in patients with angiographic coronary artery disease. Nucl Med Commun 2006;27:333–8.CrossRefPubMed

16.

Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging 2008;35:319–28.CrossRefPubMed

17.

Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535–43.PubMed

18.

Sharir T, Germano G, Kang X, Lewin HC, Miranda R, Cohen I, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001;42:831–7.PubMed

19.

Dorbala S, Vangala D, Sampson U, Limaye A, Kwong R, Di Carli MF. Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: a 82Rb PET/CT study. J Nucl Med 2007;48:349–58.PubMed

20.

Brown TL, Merrill J, Volokh L, Bengel FM. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated (82)rubidium myocardial perfusion PET. Eur J Nucl Med Mol Imaging 2008;35:336–42.CrossRefPubMed

21.

Montelatici G, Sciagrà R, Passeri A, Dona M, Pupi A. Is 16-frame really superior to 8-frame gated SPECT for the assessment of left ventricular volumes and ejection fraction? Comparison of two simultaneously acquired gated SPECT studies. Eur J Nucl Med Mol Imaging 2008;35:2059–65.CrossRefPubMed

22.

Verberne HJ, Dijkgraaf MG, Somsen GA, van Eck-Smit BL. Stress-related variations in left ventricular function as assessed with gated myocardial perfusion SPECT. J Nucl Cardiol 2003;10:456–63.CrossRefPubMed

23.

Sciagrà R, Sotgia B, Dona M, Pupi A. Influence of the postexercise acquisition delay on the detection of functional abnormalities in sestamibi-gated SPECT. J Nucl Cardiol 2007;14:334–40.CrossRefPubMed

24.

Sciagrà R, Berti V, Genovese S, Pupi A. Reliability of myocardial perfusion gated SPECT for the reproducible evaluation of resting left ventricular functional parameters in long-term follow-up. Eur J Nucl Med Mol Imaging 2010;37:1722–9.CrossRefPubMed

Title: Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities
Authors: Manjola Dona
Lucia Massi
Leonardo Settimo
Matteo Bartolini
Gianluca Giannì
Alberto Pupi
Roberto Sciagrà
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2011
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-010-1643-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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