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Reduction of the LVEF measured with gSPECT after 1-3 hours after physical exercise in CAD
W Cholewinski1, B Stefaniak, E Poniatowicz-Frasunek
1Department of Nuclear Medicine, Medical University of Lublin, SPSK4, Jaczewskiego 8, 20-954 Lublin, Poland. vitc@wp.pl
Insights
In patients with coronary artery disease (CAD), exercise stress tests can cause a decrease in left ventricular ejection fraction (LVEF) that worsens over several hours. This reduction in LVEF is linked to perfusion abnormalities and requires extended patient observation post-exercise.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Exercise can induce myocardial stunning, characterized by a temporary reduction in left ventricular ejection fraction (LVEF) even after perfusion recovery.
- The duration of post-exercise LVEF reduction requires further investigation, particularly in patients with coronary artery disease (CAD).
Purpose of the Study:
- To determine if the post-stress decrease in LVEF persists for up to 3 hours after exercise in patients with CAD.
- To evaluate the relationship between post-exercise LVEF reduction and perfusion abnormalities.
Main Methods:
- Myocardial SPECT imaging with 99mTc-tetrofosmin was performed at rest and at 1 and 3 hours post-exercise in 46 CAD patients and 10 normal controls.
- Left ventricular ejection fraction (LVEF) was calculated using the Germano method.
- A 2-day protocol was employed for rest and stress imaging.
Main Results:
- CAD patients exhibited significantly lower LVEF values compared to controls.
- In CAD patients, LVEF decreased significantly from rest to 1 hour post-stress and further decreased by 3 hours post-stress (p < 0.001).
- A significant decrease in LVEF was observed in 18/46 patients at 1 hour and 36/46 patients at 3 hours post-stress. Post-exercise LVEF reduction correlated with the severity of perfusion abnormalities (r = 0.744 at 1h, r = 0.734 at 3h).
Conclusions:
- Physical stress in diagnostic settings impairs LV function in most CAD patients.
- Post-stress LVEF reduction increases in frequency and severity between 1 and 3 hours after exercise.
- Patients with CAD undergoing stress testing require prolonged observation for several hours post-exercise due to persistent LVEF impairment.
Aim:
It has been shown that exercise may lead to the myocardial stunning with reduction of LVEF, persisting for some time despite recovery of perfusion. The aim of this study was to check whether the post-stress decrease of LVEF lasts as long as 3 h after exercise.
Patients, Methods:
The study was performed in 46 patients with CAD and in 10 normals (NMS). All patients underwent myocardial gSPECT after (99m)Tc-tetrofosmin injection at rest and during stress with 2-day protocol. SPECT was started 1h after tracer injection at rest (R) and twice: 1h (S1) and 3hs (S3) after injection at stress. LVEF was calculated by the method of Germano et al.
Results:
All LVEF values were significantly lower in CAD patients than in the control group. In NMS mean LVEF was at rest similar to those obtained 1 h and 3 h after stress injection (59.0 +/- 4.1, 60.0 +/- 5.9, 58.0 +/- 4.6, respectively; p >0.05). A post-exercise decrease of LVEF was observed in 2 normal patients both at S1 and at S3. In CAD group LVEF values were lower at S1 than at R (50.8 +/- 13.6 versus 49.3 +/- 12.8; p <0.05) and at S3 were lower than at S1 (49.3 +/- 12.8 versus 46.0 +/- 12.2;p <0.001). A significant decrease of LVEF was found in 18/46 patients 1 h post stress and in 36/46 3 h post stress. In patients with reversible perfusion decrease, a significant correlation was found between post-exercise deterioration of perfusion and post-exercise LVEF reduction both at S1 (r = 0.744; p <0.02) and at S3 (r = 0.734; p <0.02). Stress induced decrease in LVEF correlated also with severity of perfusion abnormalities.
Conclusions:
In the majority of patients with CAD physical stress applied for diagnostic purposes results in an impairment of the LV function. A decrease of the LVEF is observed 1 h after exercise, but it increases in frequency and grows stronger during the next 2 h. The post-stress LVEF reduction is related to the severity of perfusion abnormalities. Patients with CAD who underwent diagnostic stress test should remain under observation during several hours after termination of exercise.
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Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes