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Exercise QRS score (EX QRS): An indicator of extent of ischemia on myocardial perfusion scintigraphy (MPS)
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Abstracts Tuesday afternoon, April 20, 1999
35.42 EVALUATION OF POST ISCHEMIC STUNNED PATIENTS BY 99m-Tc TETROFOSMIN Gated SPECT. A. Beatett!, A. Tdulz.i, C. Di Leo, L. Tagliabue, A. Del Sole, A. Lomuscio, D. Vergani, D. Tarricone, C. Fiorentini, G.L Tarole. Cattedra di Medicina Nuoleare, Univers~ degli Studi di Milano c/o Ospedaia S.Paelo-Milano, ITALY
T U E S D A Y
Gated SPECT using Tc-gOrn labelled flow tracers provides simultaneous assessment of global and regional myocardial perfusion and function. The akn of this study was to evaluate whether regional wall thickening (WT) obtained after stress and at rest allows to identify ed analyze a subgroup of post iachemic stunned patients. Methods: we studied 20 patients (18 males) who underwent conventional diagnostic dual day stress/rsst Gated SPECT following injection of 925 MBq of 99mTc-Tetrofusmin using a dual head SPECT camera (Vertex ADAC).The mean age of these patients was 50 yrs. (38-71), 10 of whom had a history of previous AML Perfuslon was analyzed on ungated images using 20 segments scored on a 5-point scale (0=normal, 4=no uptake), while WT and motion ware assessed visuatly on atrass/rest end-systolic hnages using a 4-point score (O=normal, 3=absence of WT/mction). Left ventricular ejection fraction (LVEF) and volumes were calculated. All patients undetv~nt coronary angiegraphy. Results: All patients showed at least one reversible defect with post stress WT reduction and normal rest WT. The stunned group showed a post stress significant reduction of LVEF and a statistically non significant increase of end systolio volume (ESV). Was found a good correlation between global perfuslon and WT score both at stress and rest condition ; LVEF showed a significant inverse correlation with global post stress and rest parfusion and WT score. ESV and the global perfusion stress/rest score showed a good correlation, while and diastolic volume didn't correlate. 44% of segments with f'rxed defects presented a normal WT and normal coror~ry related vessel (false positives) ; 28% of reversible segments showed a post stress pathological WT and 5 of them a rest pathological WT. Conclusions: the gated SPECT myocardial parfusion evaluation allowed us to analyze a subgroup of post stress stunned coronary artery disease patients. The post stress LVEF reduction in this population seems to be due to the increase of endsystolic volume caused by endocardial ischemia. The stunned segments shovw~l severe perfusion defects.
P M A P R I L 20
Journal of Nuclear Cardiology January/February 1999, Part 2
35.44 EXERCISE QRS SCORE (EX QRS): AN INDICATOR OF EXTENT OF ISCHEMIA ON MYOCARDIAL PER_FUSION SCINTIGRAPHY (NIPS) Z.Yigit, N. Atmg, A.M. Esen, V. Sansoy, K. ~i~li, D. Gfizelsoy. Institute of Cardiology, University of Istanbul, Istanbul, Turkey The purpose of this study was to compare Ex QRS (Athens score) with the findings on MPS in patients with CAD. One-hundred and eighteen consecutive patients (65 men, 53 women, mean age 564-7) who underwent coronary angiography (CA) and Ex SPECT MPS were prospectively included in the study. Ex QRS was calculated based on the Ex induced changes of the Q, R and S waves in derivations aVF and V5. Patients were analysed in 3 groups (G). G 1 consisted of patients who had at least one ischemic segment on MPS and significant CAD in CA .G 2 included patients with CAD in CA, but with no ischemia on MPS, G 3 consisted of patients with normal CA and MPS. The mean QRS score of G 1 patients was significantly lower than those of G 2 and G 3 patients (p<0.01 and p< 0.0001, respectively), whereas G 2 and G 3 patients were not significantly different in this respect. The number of Ex induced myocardial perfusion defects were found to be closely related to the Ex QRS. It is concluded that Ex QRS is not only a marker of the presence, but also the extent of ischemia on MPS and may be used for risk assessment in patients with CAD.
35.43
35.45
QUANTIFICATION OF LEFT VENTRICULAR TRANSIENT ISCHEMIC DILATION (LVTID) IN TL-201 MYOCARDIALSPECT: A CLINICALVALIDATIONSTUDYIN CORONARYARTERYDISEASE. D. Daou, P. Colin, B.O. Helal, T. Fourme, A. Benada, A. Prigent, M Slama. Antoine Beclere Hospital, Clamart, France. Applying softwares dedicated to ECG-gated SPECT peffusion measurement of LV EF and volumes (V) to non-gated studies, allows the calculation of a V characteristic of the corresponding LV. We studied the correlates of this V calculated with the Multidim software when applied to non-gated TI-201 studies (VT~)and then validated its use for the calculation of LVTID as compared to coronary angiograms. Were compared in 97 pts with CAD, the VT~measured with the MulUdim method in TI-201 redistribution-reinjection SPECT versus radiological LV angiographic V. The intra and inter observer reproducibility for VT~in 48 pts were 1=0.99, difference = -0.88+6.48 ml (NS) and 1=0.99, difference = -2.44+8.29 ml (NS). VT~ was highly correlated to radiological LV end systolic V (ESVR) (1=0.9, p<0.0001). In 52/97 pts without previous PTCA, the LVTID ratio calculated as (stress Vn/reinjection Vmr) in pts with no CAD (n=12), 1-V RCA or LCx (n=9), 1-V LAD (n=9) and multivessel CAD (n= 22) were respectively 0.97+0.16""; 1.06+0.16; 1.13+0.15° and 1.13+0.19" (*or°: p<0.02). Multidim V quantification is reproducible, correlates with LV ESVR allowing objective quantification of TILVD.
ANALYSIS OF REFERRAL PATTERNS AND PREDICTIVE ACCURACY IN A N E W N U C L E A R CARDIOLOGY LABORATORY Habib A. Dakik, Hwaida Hannoush, Samir Alam, Samir Atweh. American University of Beirut, Lebanon. We analyzed the results of nuclear stress testing (NST) in a new Nuclear Cardiology Laboratory during its first 7 months of operation (1/1/98-30/7/98). A total of 206 patients (pts) were studied. Their mean age was 50+16 yrs, 78% were males and 16% had prior myocardial infarction. Reasons for referral to NST were: Evaluation of asymptomatic pts with CAD risk factors (34%), atypical chest pain (18%), typical chest pain (3%), unstable angina (12%), acute myocardial infarction (1%), follow-up after PTCA (5%), others (27%). 85 pts (41%) had an abnormal NST; 42 of them (49%) underwent coronary angiography (CA) and 38 o f those (90%) had significant coronary d.isease. Only 2 pts (2%) with normal NST underwent CA and both were normal. In conclusion, the positive predictive value of NST remains high (90%) in a new Nuclear Cardiology Laboratory although the study population tends to be low risk with only 16% of the pts being referred for typical angina or after an acute coronary syndrome.
Abstracts Tuesday afternoon, April 20, 1999
35.42 EVALUATION OF POST ISCHEMIC STUNNED PATIENTS BY 99m-Tc TETROFOSMIN Gated SPECT. A. Beatett!, A. Tdulz.i, C. Di Leo, L. Tagliabue, A. Del Sole, A. Lomuscio, D. Vergani, D. Tarricone, C. Fiorentini, G.L Tarole. Cattedra di Medicina Nuoleare, Univers~ degli Studi di Milano c/o Ospedaia S.Paelo-Milano, ITALY
T U E S D A Y
Gated SPECT using Tc-gOrn labelled flow tracers provides simultaneous assessment of global and regional myocardial perfusion and function. The akn of this study was to evaluate whether regional wall thickening (WT) obtained after stress and at rest allows to identify ed analyze a subgroup of post iachemic stunned patients. Methods: we studied 20 patients (18 males) who underwent conventional diagnostic dual day stress/rsst Gated SPECT following injection of 925 MBq of 99mTc-Tetrofusmin using a dual head SPECT camera (Vertex ADAC).The mean age of these patients was 50 yrs. (38-71), 10 of whom had a history of previous AML Perfuslon was analyzed on ungated images using 20 segments scored on a 5-point scale (0=normal, 4=no uptake), while WT and motion ware assessed visuatly on atrass/rest end-systolic hnages using a 4-point score (O=normal, 3=absence of WT/mction). Left ventricular ejection fraction (LVEF) and volumes were calculated. All patients undetv~nt coronary angiegraphy. Results: All patients showed at least one reversible defect with post stress WT reduction and normal rest WT. The stunned group showed a post stress significant reduction of LVEF and a statistically non significant increase of end systolio volume (ESV). Was found a good correlation between global perfuslon and WT score both at stress and rest condition ; LVEF showed a significant inverse correlation with global post stress and rest parfusion and WT score. ESV and the global perfusion stress/rest score showed a good correlation, while and diastolic volume didn't correlate. 44% of segments with f'rxed defects presented a normal WT and normal coror~ry related vessel (false positives) ; 28% of reversible segments showed a post stress pathological WT and 5 of them a rest pathological WT. Conclusions: the gated SPECT myocardial parfusion evaluation allowed us to analyze a subgroup of post stress stunned coronary artery disease patients. The post stress LVEF reduction in this population seems to be due to the increase of endsystolic volume caused by endocardial ischemia. The stunned segments shovw~l severe perfusion defects.
P M A P R I L 20
Journal of Nuclear Cardiology January/February 1999, Part 2
35.44 EXERCISE QRS SCORE (EX QRS): AN INDICATOR OF EXTENT OF ISCHEMIA ON MYOCARDIAL PER_FUSION SCINTIGRAPHY (NIPS) Z.Yigit, N. Atmg, A.M. Esen, V. Sansoy, K. ~i~li, D. Gfizelsoy. Institute of Cardiology, University of Istanbul, Istanbul, Turkey The purpose of this study was to compare Ex QRS (Athens score) with the findings on MPS in patients with CAD. One-hundred and eighteen consecutive patients (65 men, 53 women, mean age 564-7) who underwent coronary angiography (CA) and Ex SPECT MPS were prospectively included in the study. Ex QRS was calculated based on the Ex induced changes of the Q, R and S waves in derivations aVF and V5. Patients were analysed in 3 groups (G). G 1 consisted of patients who had at least one ischemic segment on MPS and significant CAD in CA .G 2 included patients with CAD in CA, but with no ischemia on MPS, G 3 consisted of patients with normal CA and MPS. The mean QRS score of G 1 patients was significantly lower than those of G 2 and G 3 patients (p<0.01 and p< 0.0001, respectively), whereas G 2 and G 3 patients were not significantly different in this respect. The number of Ex induced myocardial perfusion defects were found to be closely related to the Ex QRS. It is concluded that Ex QRS is not only a marker of the presence, but also the extent of ischemia on MPS and may be used for risk assessment in patients with CAD.
35.43
35.45
QUANTIFICATION OF LEFT VENTRICULAR TRANSIENT ISCHEMIC DILATION (LVTID) IN TL-201 MYOCARDIALSPECT: A CLINICALVALIDATIONSTUDYIN CORONARYARTERYDISEASE. D. Daou, P. Colin, B.O. Helal, T. Fourme, A. Benada, A. Prigent, M Slama. Antoine Beclere Hospital, Clamart, France. Applying softwares dedicated to ECG-gated SPECT peffusion measurement of LV EF and volumes (V) to non-gated studies, allows the calculation of a V characteristic of the corresponding LV. We studied the correlates of this V calculated with the Multidim software when applied to non-gated TI-201 studies (VT~)and then validated its use for the calculation of LVTID as compared to coronary angiograms. Were compared in 97 pts with CAD, the VT~measured with the MulUdim method in TI-201 redistribution-reinjection SPECT versus radiological LV angiographic V. The intra and inter observer reproducibility for VT~in 48 pts were 1=0.99, difference = -0.88+6.48 ml (NS) and 1=0.99, difference = -2.44+8.29 ml (NS). VT~ was highly correlated to radiological LV end systolic V (ESVR) (1=0.9, p<0.0001). In 52/97 pts without previous PTCA, the LVTID ratio calculated as (stress Vn/reinjection Vmr) in pts with no CAD (n=12), 1-V RCA or LCx (n=9), 1-V LAD (n=9) and multivessel CAD (n= 22) were respectively 0.97+0.16""; 1.06+0.16; 1.13+0.15° and 1.13+0.19" (*or°: p<0.02). Multidim V quantification is reproducible, correlates with LV ESVR allowing objective quantification of TILVD.
ANALYSIS OF REFERRAL PATTERNS AND PREDICTIVE ACCURACY IN A N E W N U C L E A R CARDIOLOGY LABORATORY Habib A. Dakik, Hwaida Hannoush, Samir Alam, Samir Atweh. American University of Beirut, Lebanon. We analyzed the results of nuclear stress testing (NST) in a new Nuclear Cardiology Laboratory during its first 7 months of operation (1/1/98-30/7/98). A total of 206 patients (pts) were studied. Their mean age was 50+16 yrs, 78% were males and 16% had prior myocardial infarction. Reasons for referral to NST were: Evaluation of asymptomatic pts with CAD risk factors (34%), atypical chest pain (18%), typical chest pain (3%), unstable angina (12%), acute myocardial infarction (1%), follow-up after PTCA (5%), others (27%). 85 pts (41%) had an abnormal NST; 42 of them (49%) underwent coronary angiography (CA) and 38 o f those (90%) had significant coronary d.isease. Only 2 pts (2%) with normal NST underwent CA and both were normal. In conclusion, the positive predictive value of NST remains high (90%) in a new Nuclear Cardiology Laboratory although the study population tends to be low risk with only 16% of the pts being referred for typical angina or after an acute coronary syndrome.