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Validation of automatic gated SPECT ejection fraction versus radionuclide ventriculography
Journal of Nuclear Cardiology
Abstracts
Volume 6, Number 1, Part 2
S 107
Wednesday afternoon,April 21, 1999
54.24
54.26
CHANGES IN LEFT VENTRICULAR SYSTOLIC AND DIAS T O L I C F U N C T I O N IN PATIENTS W I T H O U T H E A R T FAIL U R E D U R I N G AND A F T E R T R E A T M E N T FOR ADVANCED B R E A S T C A N C E R W I T H EPIRUBICIN.
RADIONUCLIDE VENTRICULOGRAPHY (RNV) AND 2D-ECHOCARDIOGRAPHY (2D-ECHO) FOR ASSESSING LEFT VENTRICULAR WALL MOTION AFTER MITRAL VALVE SURGERY. G. Villa, V. Dottori, P. Vinci, E. Safaie Senmami, A. Rahimi Mansour, R. Zoccola*, G.Mariani. Nucl. Med., DIMI, Univ. of Genoa; Card. Div., S. Martino Hosp. of Genoa; Nucl. Med., Alessandria; (Italy).
Bente Schaadt, Birger Hesse, Henning Kelba~k Rigshospitaler, University of Copenhagen, Denmark Background: Anthracycline treatment may be complicated by development of cardiomyopathy, which has been suggested to be of a restrictive nature. Methods: 67 patients, treated with epirubicin to 1000 mg/m2 because of advanced breast cancer, had radionuclide cardiography performed before, during and 6 months after treatment. In every second patient determination of left ventricular peak filling rate (PFR) to evaluate the diastolic function, and in the remainder left ventricular (LV) volumes was performed. 8 patients developed clinical heart failure. Results: In the patients without heart failure a fall in LV ejection fraction (EF) was recorded after 500 mg/m2 and LV volumes in:reased, no change was seen in PFR. At high cumulative doses there were no further changes in LVEF or volumes, but a significant fall in PFR. After treatment PFR was improved, without any change in LVEF. Conclusion: In patients who did not develop clinical heart failure, slight irreversible impairment of systolic function was observed early during treatment and slight reversible impairment of diastolic function at maximal cumulative doses.
54.25
The left ventricular performance at 6 months after surgery was measured by RNV and estimated by 2D-Echo in patients who had undergone either endovalvular prosthetic implantation (EVPI, n = 20), rnitral valve reconstruction (MVR, n = 20), or standard mitral valve replacement (SMVR, n = 22), All patients had similar preoperative left ventricular performance status (functional class III). EVPI MVR SMVR RNV
LVEF (%) EDLVV(rnl) ESLVV (ml)
45.9+11.2 91.3±37.2 48.3_+24.3
51.9±10.3 39.I+_14.4 137.7_+62.1 121.3_+82.1 69.1 +39.0 81.3_+69.9
2D-Echo
LVEF (%) EDLW(rrd) ESLVV (ml)
55.2_+13.6 63.2_+9.8 48.2_+7.4 126.8_+67.3 163.0+_37.4 156.8+62.0 69.0_+36.0 87.5_+13.5 74.1_+26.5
Standard mitral valve replacement resulted in the worst long-term left ventricular performance. 2D-Echo grossly overestimated left ventricular volumes and ejection fractions versus standard RNV.
54.27
VALIDATION OF AUTOMATIC GATED SPECT EJECTION FRACTION VERSUS RADIONUCLIDE VENTRICULOGRAPHY. E Alexanderson, V.Varguez, I Apolo, E Becket, T Colmenares, P Lemus, D Victoria. Instituto Nacional de Cardiologia "Ignacio Chavez".Mexico City, MEXICO. Radionuclide ventriculography with gated equilibrium blood pool technique(RVG) provides a noninvasive way to evaluate ventricular function quantitatively and the method is considered one of the most precised to obtain left ventricle ejection fraction(LVEF). Recently, Gated SPECT program allows to evaluate simultaneously myocardial perfusion and ejection fraction. The goal of this study is to validate ejection fraction obtained with Cedars- Germano Gated SPECT program compared with that of RVG. METHOD: We studied 50 consecutive patients with chronic ischemic heart disease, using 3 mCi rest TI-201 SPECT followed by 25 mCi stress sestamibi injection gating the images and obtaining ejection fraction value. RVG was performed 3 days after perfusion study using Tc-99 RBC in vivo technique obta!ning images in left anterior oblique position. P~SULTS: 100
GATED R=0.912
L E F T V E N T R I C U L A R SYSTOLIC AND DIASTOLIC F U N C T I O N DURING EXERCISE [1N N O R M A L S AND PATIENTS W I T H C O R O N A R Y ARTERY DISEASE AND C O N G E S T I V E H E A R T FAILURE N. D. Georgakopoulos, C. Foster, IC Mayer, A. Ahmad, Milwaukee Heart Institute, Milwaukee, W I Changes in systolic fi.mction o f the left ventricle (LVEF) between rest and exercise have been well described. There is little information regarding changes in diastolic function between rest and exercise. We compared LVEF and normalized Peak Filling Rate (PFR) (index o f diastolic function) between rest and u p r i # t cyeIe exercise at ventilatory threshold in healthy volunteers (CONTROL), pts with CAD but no exertional ischemia and pts with stable CHF using first pass radionuclide ventriculography. In CONTROL there were normal responses of LVEF and PFR fi'om rest to exercise; in CAD the LVEF showed normal response but the PFR showed only a modest increase. In the CHF group, both LVEF and PFR were low at rest and showed modest improvement during exercise. LVEF(%)
5O 0
NcrmaIs CAD CHF
PFR(EDVls)"
Rest
Ex
Rest
62.~.B 61±B 36"12
77"-8 68±7 43±12
Z8~.5
EX
6_+0.9 2.2--'~0.4 4.2~1.7 1.5z0.6 2.7±0.9
W E D N E S D A Y P M A
"in EndDiastolicVolumesoer secondfEOV/s)
CONCLUSIONS: There is a good correlation between LVEF obtained from Gated SPECT program and from RVG. Correlation is good for normal and abnormal cases.
We conclude that the magnitude of augmentation in PFR. may be compromised in pts with CAD and CHF even if the systolic LV response to exercise is relatively normal. Measures of diastolic ffmcdon may differentiate abnormalities of LV function not revealed
by LVEF.
21
Abstracts
Volume 6, Number 1, Part 2
S 107
Wednesday afternoon,April 21, 1999
54.24
54.26
CHANGES IN LEFT VENTRICULAR SYSTOLIC AND DIAS T O L I C F U N C T I O N IN PATIENTS W I T H O U T H E A R T FAIL U R E D U R I N G AND A F T E R T R E A T M E N T FOR ADVANCED B R E A S T C A N C E R W I T H EPIRUBICIN.
RADIONUCLIDE VENTRICULOGRAPHY (RNV) AND 2D-ECHOCARDIOGRAPHY (2D-ECHO) FOR ASSESSING LEFT VENTRICULAR WALL MOTION AFTER MITRAL VALVE SURGERY. G. Villa, V. Dottori, P. Vinci, E. Safaie Senmami, A. Rahimi Mansour, R. Zoccola*, G.Mariani. Nucl. Med., DIMI, Univ. of Genoa; Card. Div., S. Martino Hosp. of Genoa; Nucl. Med., Alessandria; (Italy).
Bente Schaadt, Birger Hesse, Henning Kelba~k Rigshospitaler, University of Copenhagen, Denmark Background: Anthracycline treatment may be complicated by development of cardiomyopathy, which has been suggested to be of a restrictive nature. Methods: 67 patients, treated with epirubicin to 1000 mg/m2 because of advanced breast cancer, had radionuclide cardiography performed before, during and 6 months after treatment. In every second patient determination of left ventricular peak filling rate (PFR) to evaluate the diastolic function, and in the remainder left ventricular (LV) volumes was performed. 8 patients developed clinical heart failure. Results: In the patients without heart failure a fall in LV ejection fraction (EF) was recorded after 500 mg/m2 and LV volumes in:reased, no change was seen in PFR. At high cumulative doses there were no further changes in LVEF or volumes, but a significant fall in PFR. After treatment PFR was improved, without any change in LVEF. Conclusion: In patients who did not develop clinical heart failure, slight irreversible impairment of systolic function was observed early during treatment and slight reversible impairment of diastolic function at maximal cumulative doses.
54.25
The left ventricular performance at 6 months after surgery was measured by RNV and estimated by 2D-Echo in patients who had undergone either endovalvular prosthetic implantation (EVPI, n = 20), rnitral valve reconstruction (MVR, n = 20), or standard mitral valve replacement (SMVR, n = 22), All patients had similar preoperative left ventricular performance status (functional class III). EVPI MVR SMVR RNV
LVEF (%) EDLVV(rnl) ESLVV (ml)
45.9+11.2 91.3±37.2 48.3_+24.3
51.9±10.3 39.I+_14.4 137.7_+62.1 121.3_+82.1 69.1 +39.0 81.3_+69.9
2D-Echo
LVEF (%) EDLW(rrd) ESLVV (ml)
55.2_+13.6 63.2_+9.8 48.2_+7.4 126.8_+67.3 163.0+_37.4 156.8+62.0 69.0_+36.0 87.5_+13.5 74.1_+26.5
Standard mitral valve replacement resulted in the worst long-term left ventricular performance. 2D-Echo grossly overestimated left ventricular volumes and ejection fractions versus standard RNV.
54.27
VALIDATION OF AUTOMATIC GATED SPECT EJECTION FRACTION VERSUS RADIONUCLIDE VENTRICULOGRAPHY. E Alexanderson, V.Varguez, I Apolo, E Becket, T Colmenares, P Lemus, D Victoria. Instituto Nacional de Cardiologia "Ignacio Chavez".Mexico City, MEXICO. Radionuclide ventriculography with gated equilibrium blood pool technique(RVG) provides a noninvasive way to evaluate ventricular function quantitatively and the method is considered one of the most precised to obtain left ventricle ejection fraction(LVEF). Recently, Gated SPECT program allows to evaluate simultaneously myocardial perfusion and ejection fraction. The goal of this study is to validate ejection fraction obtained with Cedars- Germano Gated SPECT program compared with that of RVG. METHOD: We studied 50 consecutive patients with chronic ischemic heart disease, using 3 mCi rest TI-201 SPECT followed by 25 mCi stress sestamibi injection gating the images and obtaining ejection fraction value. RVG was performed 3 days after perfusion study using Tc-99 RBC in vivo technique obta!ning images in left anterior oblique position. P~SULTS: 100
GATED R=0.912
L E F T V E N T R I C U L A R SYSTOLIC AND DIASTOLIC F U N C T I O N DURING EXERCISE [1N N O R M A L S AND PATIENTS W I T H C O R O N A R Y ARTERY DISEASE AND C O N G E S T I V E H E A R T FAILURE N. D. Georgakopoulos, C. Foster, IC Mayer, A. Ahmad, Milwaukee Heart Institute, Milwaukee, W I Changes in systolic fi.mction o f the left ventricle (LVEF) between rest and exercise have been well described. There is little information regarding changes in diastolic function between rest and exercise. We compared LVEF and normalized Peak Filling Rate (PFR) (index o f diastolic function) between rest and u p r i # t cyeIe exercise at ventilatory threshold in healthy volunteers (CONTROL), pts with CAD but no exertional ischemia and pts with stable CHF using first pass radionuclide ventriculography. In CONTROL there were normal responses of LVEF and PFR fi'om rest to exercise; in CAD the LVEF showed normal response but the PFR showed only a modest increase. In the CHF group, both LVEF and PFR were low at rest and showed modest improvement during exercise. LVEF(%)
5O 0
NcrmaIs CAD CHF
PFR(EDVls)"
Rest
Ex
Rest
62.~.B 61±B 36"12
77"-8 68±7 43±12
Z8~.5
EX
6_+0.9 2.2--'~0.4 4.2~1.7 1.5z0.6 2.7±0.9
W E D N E S D A Y P M A
"in EndDiastolicVolumesoer secondfEOV/s)
CONCLUSIONS: There is a good correlation between LVEF obtained from Gated SPECT program and from RVG. Correlation is good for normal and abnormal cases.
We conclude that the magnitude of augmentation in PFR. may be compromised in pts with CAD and CHF even if the systolic LV response to exercise is relatively normal. Measures of diastolic ffmcdon may differentiate abnormalities of LV function not revealed
by LVEF.
21