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Acute changes in LV-function during PTCA. Global LVEF as a measure of preconditioning?
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
67.10 Assessment of Regional LV Function by Gated Tc-99m TETROFOSM1N SPECT AND FOURIER ANALYSIS. H.Maruno, M.Onoguchi, H.Toyama, K.Yoshioka, N.Komiyama, H.Murata, ToranomonHospital,Tokyo, Japan We have developed a new .quantitative program to generate automatically polar maps displaying several LV functional parameters (Functional G-maps) with gated SPECT and Fourier analysis. In this study, the utility of Functional Gmaps for chnical use was investigated. Fourteen normal subjects, 25 patients with coronary artery disease(CAD), and 12 patients with hypertrophic cardiomyopathy(HCM) were studied.Myocardial wall thickening and thinning in a cardiac cycle was analyzed for the optimal short axis images. The epicardial boundaries of LV were automatically defined and from the center of LV cavity 40 radii were generated, and a short axis image was divided into 40 segments. The regional time-activity curye was made from these sequential images. The rouowmg quantitative parametet~ were calculated in each se~rnent by means of the regional time-activity curve and funoermental Fourier component, and polar maps were generated using the oarameters of all short axis slices. 1)Minimum co~t (MIN), 2)Maximum count (MAX), 3)Count increase (t~) 4)% count increase (%CI), 5) Peak contraction rate (PCR) 6)Peak distension rate (PDR) and 7)Contraction time (CT) were calculated. CI, %CI and CT were useful for assessment of CAD and associated functional disorder. PCR and PDR could demonstrate myocardial contractility and distensibility in HCM. In conclusion, the Functional G-maps were useful for evaluation of regional LV function in various clinical situations.
Abstracts Tuesday afternoon, April 8, 1997
$75
67.12 ROLE OF STUNNED MYOCARDIUM IN RECOVERY OF FUNCTION AND PERFUSION DURING 6 MONTHS AFTER ACUTE MYOCARDIAL INFARCTION. Medolago G.,Costalunga A.,Piti A.,Rondi M.,Ghilardi A.
Nuclear Cardiology DPT. Ospedali RiunitL Bergamo, Italy. Spontaneous recovery of the perfusion defect assessed by Tc99" SESTAMIBI and associated improvement of regional kinesis several months following AMI was reported. Stunned, hybernating myocardium, and recruiment of collateral vessels were suggested in physiopathology of this phenomenon. In order to better understand this event. 18 consecutive patients (15 males and 3 females; mean age:52 ys) undergone direct PTCA for their first AMI were studied. In all patients complete opening of the infarct related artery (IRA) and TIMI 3 grade flow was obtained. Echocardiographic examination and resting regional myocardial perfusion and LV function assessed by Tc~')"SESTAMIBI SPECT were performed during the first week after AMI and repeated 3 and 6 months later. In all patients no events were observed during the follow-up period.; at 6th month coronary angiography performed in 4 patients showed patency of the IRA and persistent TIMI 3 grade flow in all angiograms. Results showed reduction of the extension and severity of the perfusion defect and concomitant improvement of the regional kinesis evaluated by wall motion index (WMI) at the third month (p< 0.05) and were unmodified at 6 months. No significant changes in EF and LV volumes, both assessed by echocardiography and RNA First Pass, were observed. In conclusion, data confirmed improvement of LV perfusion and contraction after AMI, and showed stunned myocardium as main factor in determining this phenomenon.
T U E S D A Y P M
67.11 ACUTE CHANGES IN LV-FUNCTION DURING PTCA. GLOBAL LVEF AS A MEASURE OF PRECONDITIONING? TB.Lindhardt, H.Kelb~ek, K.Saunamaki, JK.Madsen, P.Clenu-nensen, B.Hesse, N.Gadsboll. The Rigshospital. Copenhagen, Denmark. Purpose: To study the acute impact of PTCA on LV-function and the effect &two balloon dilatations (BD) on global LVEF and the ECG. Methods: LV-function was monitored in 40 patients with a miniature nuclear detector (Cardioscim®). Red blood cells were labeled with 800 Mbq 99mTc.Ten patients received two consecutive and identical BD. The ECG ST-segment deviations (STA) in the 12 leads were summated. Mean duration of balloon inflation: 113 +_45 see. Results: Pre-PTCA PTCA Post-PTCA LVEF: ,63 +-. 10 .51 +_. 14 * .65 -+. l 0 * * P<0.05 LVEDC: 78+- 19 79_+ 19 78-+ 19 LVESC: 29+ 12 39+ 16" 29-+ 12 LVEDC, LVESC: LV end-diastolic and end-systolic counts/l 0ms. 65% of the patients with LAD disease had a decrease in LVEF > 10 EF units, the corresponding figures for CX and RCA were 33% and 25%, respectively. The decrease in LVEF and the return to pre-PTCA levels occurred within seconds after balloon inflation and deflation. Compared to the initial BD the second BD was associated with significantly less decrease in LVEF (difference 7%, p<0.05) and also less summated STA (difference 30%, p<0.05). Conclusion: There was a significant and abrupt decrease in LVEF during PTCA explained by an increase in ESV with no change in EDV. The effect on LVEF was most pronounced in patients undergoing dilatation of LAD. No patients showed any sign of postPTCA stunning. In the 10 patients who received two BD our findings suggest that preconditioning can be induced in humans during PTCA.
67.13 CORRELATION OF A C U T E T C - 9 9 M SPECT IMAGING AND CORONARY ARTERY DISEASE AT Fossati, RS Morris, AW Ahlberg, GM Cyr, C McGiU, A Russell, MP White, FJ Wackers, GV Heller, Hartford Hospital, University of Connecticut, Hartford, CT, USA Limited data is available on the predictive value (PV) of acute myocardial perfusion imaging (MPI) in identifying coronary artery disease (CAD). We evaluated 150 patients utilizing Te-99m SPECT imaging within five hours of chest pain (CP). All patients underwent subsequent stress imaging, cardiac catheterization, or both. Images were read blinded. Results were correlated to determine the PV of acute MPI in identifying CAD for the total population, males and females, with and without CP during injection. Results: All Pts (n=150) M (n=91) F (n=59) + PV (%) 69 70 67 - PV (%) 76 72 82 Pts with CP (n=50) M (n=28) F (n-22) !+PV(%) 84 77 100 - PV (%) 68 60 75 Conclusion: The positive predictive value of acute Tc99m SPECT imaging improves in patients who are injected during active chest pain.
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67.10 Assessment of Regional LV Function by Gated Tc-99m TETROFOSM1N SPECT AND FOURIER ANALYSIS. H.Maruno, M.Onoguchi, H.Toyama, K.Yoshioka, N.Komiyama, H.Murata, ToranomonHospital,Tokyo, Japan We have developed a new .quantitative program to generate automatically polar maps displaying several LV functional parameters (Functional G-maps) with gated SPECT and Fourier analysis. In this study, the utility of Functional Gmaps for chnical use was investigated. Fourteen normal subjects, 25 patients with coronary artery disease(CAD), and 12 patients with hypertrophic cardiomyopathy(HCM) were studied.Myocardial wall thickening and thinning in a cardiac cycle was analyzed for the optimal short axis images. The epicardial boundaries of LV were automatically defined and from the center of LV cavity 40 radii were generated, and a short axis image was divided into 40 segments. The regional time-activity curye was made from these sequential images. The rouowmg quantitative parametet~ were calculated in each se~rnent by means of the regional time-activity curve and funoermental Fourier component, and polar maps were generated using the oarameters of all short axis slices. 1)Minimum co~t (MIN), 2)Maximum count (MAX), 3)Count increase (t~) 4)% count increase (%CI), 5) Peak contraction rate (PCR) 6)Peak distension rate (PDR) and 7)Contraction time (CT) were calculated. CI, %CI and CT were useful for assessment of CAD and associated functional disorder. PCR and PDR could demonstrate myocardial contractility and distensibility in HCM. In conclusion, the Functional G-maps were useful for evaluation of regional LV function in various clinical situations.
Abstracts Tuesday afternoon, April 8, 1997
$75
67.12 ROLE OF STUNNED MYOCARDIUM IN RECOVERY OF FUNCTION AND PERFUSION DURING 6 MONTHS AFTER ACUTE MYOCARDIAL INFARCTION. Medolago G.,Costalunga A.,Piti A.,Rondi M.,Ghilardi A.
Nuclear Cardiology DPT. Ospedali RiunitL Bergamo, Italy. Spontaneous recovery of the perfusion defect assessed by Tc99" SESTAMIBI and associated improvement of regional kinesis several months following AMI was reported. Stunned, hybernating myocardium, and recruiment of collateral vessels were suggested in physiopathology of this phenomenon. In order to better understand this event. 18 consecutive patients (15 males and 3 females; mean age:52 ys) undergone direct PTCA for their first AMI were studied. In all patients complete opening of the infarct related artery (IRA) and TIMI 3 grade flow was obtained. Echocardiographic examination and resting regional myocardial perfusion and LV function assessed by Tc~')"SESTAMIBI SPECT were performed during the first week after AMI and repeated 3 and 6 months later. In all patients no events were observed during the follow-up period.; at 6th month coronary angiography performed in 4 patients showed patency of the IRA and persistent TIMI 3 grade flow in all angiograms. Results showed reduction of the extension and severity of the perfusion defect and concomitant improvement of the regional kinesis evaluated by wall motion index (WMI) at the third month (p< 0.05) and were unmodified at 6 months. No significant changes in EF and LV volumes, both assessed by echocardiography and RNA First Pass, were observed. In conclusion, data confirmed improvement of LV perfusion and contraction after AMI, and showed stunned myocardium as main factor in determining this phenomenon.
T U E S D A Y P M
67.11 ACUTE CHANGES IN LV-FUNCTION DURING PTCA. GLOBAL LVEF AS A MEASURE OF PRECONDITIONING? TB.Lindhardt, H.Kelb~ek, K.Saunamaki, JK.Madsen, P.Clenu-nensen, B.Hesse, N.Gadsboll. The Rigshospital. Copenhagen, Denmark. Purpose: To study the acute impact of PTCA on LV-function and the effect &two balloon dilatations (BD) on global LVEF and the ECG. Methods: LV-function was monitored in 40 patients with a miniature nuclear detector (Cardioscim®). Red blood cells were labeled with 800 Mbq 99mTc.Ten patients received two consecutive and identical BD. The ECG ST-segment deviations (STA) in the 12 leads were summated. Mean duration of balloon inflation: 113 +_45 see. Results: Pre-PTCA PTCA Post-PTCA LVEF: ,63 +-. 10 .51 +_. 14 * .65 -+. l 0 * * P<0.05 LVEDC: 78+- 19 79_+ 19 78-+ 19 LVESC: 29+ 12 39+ 16" 29-+ 12 LVEDC, LVESC: LV end-diastolic and end-systolic counts/l 0ms. 65% of the patients with LAD disease had a decrease in LVEF > 10 EF units, the corresponding figures for CX and RCA were 33% and 25%, respectively. The decrease in LVEF and the return to pre-PTCA levels occurred within seconds after balloon inflation and deflation. Compared to the initial BD the second BD was associated with significantly less decrease in LVEF (difference 7%, p<0.05) and also less summated STA (difference 30%, p<0.05). Conclusion: There was a significant and abrupt decrease in LVEF during PTCA explained by an increase in ESV with no change in EDV. The effect on LVEF was most pronounced in patients undergoing dilatation of LAD. No patients showed any sign of postPTCA stunning. In the 10 patients who received two BD our findings suggest that preconditioning can be induced in humans during PTCA.
67.13 CORRELATION OF A C U T E T C - 9 9 M SPECT IMAGING AND CORONARY ARTERY DISEASE AT Fossati, RS Morris, AW Ahlberg, GM Cyr, C McGiU, A Russell, MP White, FJ Wackers, GV Heller, Hartford Hospital, University of Connecticut, Hartford, CT, USA Limited data is available on the predictive value (PV) of acute myocardial perfusion imaging (MPI) in identifying coronary artery disease (CAD). We evaluated 150 patients utilizing Te-99m SPECT imaging within five hours of chest pain (CP). All patients underwent subsequent stress imaging, cardiac catheterization, or both. Images were read blinded. Results were correlated to determine the PV of acute MPI in identifying CAD for the total population, males and females, with and without CP during injection. Results: All Pts (n=150) M (n=91) F (n=59) + PV (%) 69 70 67 - PV (%) 76 72 82 Pts with CP (n=50) M (n=28) F (n-22) !+PV(%) 84 77 100 - PV (%) 68 60 75 Conclusion: The positive predictive value of acute Tc99m SPECT imaging improves in patients who are injected during active chest pain.
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