Dobutamine radionuclide ventriculography: Prediction of ventricular function improvement after bypass surgery in patients with ischemic cardiomyopathy

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Abstracts Wednesday afternoon, April 9, 1997

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LEFT VENTRICULAR WALL MOTION ASSESSMENT: COMPARISON BETWEEN GATED SPECT VENTRICULOGRAPHY AND ECHOCARDIOGRAPHY

DOBUTAMINE RADIONUCLIDE VENTR1CULOGRAPHY: Prediction of Ventricular Function Improvement After Bypass SurgeD' in Patients with Ischemic Cardiomyopathy N.Zafrir, B.Vidne, R.Basse~4tch, SSclarovsky, E.Lubin, Rabin Medical Center, Beilinson Campus, Israel Ventricular function may improve after coronary B'pass surgeD' (CABG) in patients (pts) ~4th ischemic cardiomyopathy (IC) depending on the amount of contractile myocardial reserve. The use of low-dose dobutamine (DOB) radionuclide ventriculography (RNY) in the assessment of functional contractile reserve has not been criticaUy evaluated. We prospectively studied 35 pts with IC (mean EF 23+5%) and triple vessel disease one month prior to CABG. All underwent a 2-day protocol: day 1 - Tc 99m sestamibi (SM) (25mci) SPECT imaging at rest, performed for viabili~" scoring (15 segments); day 2 - RNV prior to and during infusion of 5 and 10 gg/kg/min of DOB. An increase of global EF from rest to DOB was calculated and value of 10% was considered as cutoff for predictive value. Two pts died within one month of CABG. The rest (33 pts) were followed for 12+5 months. Of these, 16 showed improvement (AEF >5% mean 10+5%) and 17 did not (AEF <5% mean -1+3%). An increase of DOB EF was demonstrated as the most uni~ariate predictor for EF improvement after CABG. The sensitivity, Specificity, positive and negative predictive values of DOB RNV were 65%, 92%, 92% and 67%, r e ~ v e l y . Conclusions: DOB RNV is a useful method to assess and predict functional improvement after CABG in pts with IC. However, a low negative predictive value may be a result of severe ischemia provoked by a low-dose DOB.

CIOGLIA G, SCHINTU B, CHERCHI A ; Institute of Cardiology, University of Cagliari, Italy The study compared gated spect ventriculography (GSV) and echocardingraphy (ECHO) in the evalutation of left ventricular wall motion. GSV and ECHO was performed at rest, in the same day, in 15 subjects with ventricular dysfunction and alterations of contractility secondary to ischemic and idiopathic cardiomyopathy, clinically stable. The patients underwent contrast ventriculograph), (CV) and angiography within 1 week. No significant differences were found between mean score of regional contractility given to each segment by GSV and ECHO. Abnormal regional wall motion was observed by both the tecniques in 2 of 3 patients with single vessel disease and in 2 of 3 with double vessel disease, GSV has pointed out alterations in 4 of 5 and ECHO in 5 of 5 subjects with triple vessel disease. Abnormal regional contractility was detected in 8 of 11 patients with significant coronary stenosis by GSV and in 9 of 11 by ECHO. Abnormal global contractility was observed by both the tecniques too, in 2 of 4 patients without coronary disease, but with dilatative cardiomiopathy and decreased ejection fraction (EF). A significant linear correlation was found between EF measured by GSV ( mean value 40 +/- 22% ) and ECHO ( 44+/- 17% ), R 0,89 , P<0,001. Moreover a significant correlation was calculated between EF measured by GSV and CV ( 48+/-21% ), R 0,87 P<0,001. GSV correlates with echoeardiographic assesment of regional and global function and with angiographyc findings.

W E D N E S D A Y P M A P R I L

Journal of Nuclear Cardiology January/February 1997, Part 2

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COMPARISON OF THE VALUE BETWEEN RADIONUCLIDE ANGIOGRAPHY AND ELECTRON-BEEM CT IN A S S E S S I N G LEFT V E N T R I C U L A R F U N C T I O N ST.Li, XJ.Liu, RP.Dai, RF.Shi, SX.Zhang, ZM.Yao, Yz.Liu.Fu Wai Hospital, CAMS & PUMC, Beijing, China.

RELATION OF EJECTION F R A C T I O N C H A N G E WITH E X E R C I S E TO EJECTION F R A C T I O N AT REST IN C O R O N A R Y ARTERY DISEASE P.G. Supino, E.M. Herrold, J.P. Teevan, J.S. Borer. Cornell Medical Center. New York, NY, USA

To compare the radionuelide angiography(RNA) and EBCT in assessing LV function, 23 pts (60-+ 8yrs,22M,1F) with CAD were studied. R N A was performed using Siemens multiSPECT system with LEAP collimator by Tc-99m labeling o f RBC(in vivo)at ANT, 30°LAO and 70°LAO views. L V function was measured by Imatron C-150 EBCT system at the views o f ANT, 30°LAO.Student's paired t-test and C o h e n ' s Kappa test were used to identify the difference and agreement between RNA and EBCT. The results were showed following: RNA EBCT ,/ EF 55.4 +- 19.4% 46.9+- 11.8% 0:85 abn.WM 41 segments 38 segments K=0.584, P<0.05 In conclusion: There was a significant correlation between R N A and E B C T in assessment o f LV function and regional wall motion.

Change (A) in LV ejection fraction(EF) from rest(r) to exercise(ex) is a primary prognostic index in pts with coronary artery disease(CAD) but discrepancies have been reported in its independent value, possibly resulting from a systemic relation between the magnitude and variation in ALVEF and absolute LVEFr. To test this hypothesis, we analyzed data from 2764 clinically stable, non-operated pts who underwent r and ex radionuclide cineangiography for CAD, substratified tbr LVEFr: < 3 0 % ( n = 2 1 4 ) , 3040 %(n = 5 9 5 ) , 60-75 %(n = 3 3 6 ) and > 75 %(n = 3 4 ) . For all pts, LVEFr=48.3___ 11.7% and LVEFex=48.7_+ 15.6%. Standard deviation of A L V E F (ASD) in pts with L V E F r < 3 0 % was 4.1%, substantially less than in other subgroups (ASD 7.8% to 9.9% [ p < . 0 0 0 1 , L V E F r < 3 0 % vs. other subgroups]). Also, absolute magnitude of av ALVEF was substantially smaller (p < . 0 0 0 1 ) in pts with L V E F r < 3 0 % than others. Thus, LVEFex is strongly dependent on LVEFr and is more closely tied to L V E F r in the markedly subnormal range.