Original ArticleQuantitation of left ventricular ejection fraction reserve from early gated regadenoson stress Tc-99m high-efficiency SPECT
Introduction
Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established non-invasive procedure for evaluation and risk stratification of patients with coronary artery disease (CAD).1 However, it has been recognized that with certain patients, SPECT MPI does not allow to detect the presence nor to estimate the extent of CAD. Indeed, the moderate to severe perfusion defects are revealed in less than half of the patients with significant left main disease.2 A number of studies have been conducted to improve the sensitivity of SPECT MPI, through the analysis of post-stress left ventricular (LV) ejection fraction (EF),3,4 post-stress wall motion abnormalities,5 and transient LV dilation,6 but these investigations have been made using conventional Anger cameras with waiting periods after stress tracer injection as long as 60 minutes. Such delayed EF measurements seem to be relatively ineffective for the detection of significant CAD, as a result of their transient nature. The ability of PET MPI to measure EF and to determine EF reserve during peak of stress using highly sensitive detectors and high-dose short-lived tracers has been reported.7 Recently, a novel high-efficiency (HE) SPECT camera with solid state cardiac-focused detectors has shown to be significantly more sensitive for the detection of cardiac activity than the conventional Anger scintillation camera,8, 9, 10 giving SPECT a “PET-like” ability to image rapidly during a peak of stress. The aim of this study was to explore the feasibility of evaluating EF reserve using HE-SPECT.
Section snippets
Study Population
The patients of the study were selected from consecutive subjects who were referred to clinically indicated regadenoson pharmacologic stress MPI to the Nuclear Medicine Department, Sacred Heart Medical Center, Springfield, Oregon, between August 2012 and August 2013. The selection of the patients depended on the limitations related to the scheduling of a non-routine imaging protocol, in particular the availability of the stress lab staff and nurses during the entire procedure. Fifty consecutive
Results
Baseline clinical characteristics of studied patients are presented in Table 1. Overall, 22 patients (44%) had stress TPD = 0 %; stress TPD >0 % was seen in 28 patients. 40 patients did not have significant ischemia (ITPD <5%), and 10 patients had significant ischemia (ITPD ≥5%). Gated resting EF <50% was recorded in 14 patients (28%).
Discussion
To the best of our knowledge, this is the first study evaluating feasibility of EF reserve quantification obtained from early gated acquisitions using Tc-99m HE-SPECT MPI. The main discovery in our study is that the EF reserve obtained from early gated acquisitions (obtain 5 and 9 minutes after injection) showed concordance with significant myocardial ischemia, while later acquisitions (at 13th, 17th and 21st minute) or standard HE-SPECT gated acquisitions did not. According to our findings,
Conclusions
We have demonstrated the feasibility of early EF reserve measurement with HE-SPECT. Negative EF reserve obtained between 5th and 9th minutes of regadenoson stress demonstrated best concordance with significant ischemia and could be a promising clinical tool for detection of early ischemic functional changes with Tc-99m HE-SPECT.
Acknowledgment
This research was supported in part by Grant R01HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH) (PI: Piotr Slomka). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI/NIH. Yafim Brodov, MD, PhD is a Michael Kogan Save a Heart Foundation fellow in Cardiac Imaging and Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
Disclosure
Drs Piotr Slomka, Guido Germano,
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JNC thanks Dr. E. Alexanderson, UNAM, Mexico, for providing the Spanish abstract, and Weihua Zhou, PhD, University of Southern Mississippi, USA, for providing the Chinese abstract. An audio interview between Dr. Slomka and the editor-in-chief, Dr. Iskandrian, discussing the article can be found as Electronic Supplementary Material at SpringerLink.
See related editorial, doi:10.1007/s12350-016-0570-8.