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Related Experiment Videos

Adenosine-induced long-standing postischemic left ventricular dysfunction evaluated with gated SPECT.

Kyung Ah Chun1, Ihn Ho Cho

  • 1Department of Nuclear Medicine, Yeungnam University Hospital, Daegu, Korea.

Clinical Nuclear Medicine
|December 18, 2004
PubMed
Summary

Adenosine stress can cause temporary left ventricular (LV) dysfunction, particularly in patients with reversible perfusion defects. This postischemic dysfunction is detectable with gated SPECT imaging, even hours after stress.

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Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Myocardial Perfusion Imaging

Background:

  • Pharmacologic stress testing with adenosine is used to assess myocardial perfusion.
  • Left ventricular (LV) function parameters include end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (LVEF).
  • Single-photon emission computed tomography (SPECT) with Tl-201 and Tc-99m MIBI is a common imaging modality.

Purpose of the Study:

  • To determine the after-effects of adenosine pharmacologic stress on LV function.
  • To evaluate LV function parameters (EDV, ESV, LVEF) using Tl-201 and Tc-99m MIBI SPECT.
  • To assess the impact of timing between isotope injection and imaging on these after-effects.

Main Methods:

  • 263 patients were divided into three groups based on imaging time: Group A (within 1 hour), Group B (1-2 hours), and Group C (2-3 hours).

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  • Patients were subgrouped into no perfusion defect (NPD), reversible defect (RD), and fixed defect (FD).
  • LV function parameters (EDV, ESV, LVEF) were assessed using gated SPECT.

    • Main Results:

    • In Group A, patients with RD showed significantly depressed post-stress LVEF (53.1% vs 58.3%, P < 0.001) and worse wall motion compared to rest.
    • The mean LVEF difference (DeltaLVEF) was significantly higher in RD patients (5.2%) compared to NPD (0.9%) and FD (2.1%) subgroups.
    • Post-stress ESV was significantly higher in RD patients, while EDV showed no significant difference; these effects were less pronounced in later imaging groups.

    Conclusions:

    • Adenosine stress-induced postischemic LV dysfunction is evident on early quantitative gated SPECT in patients with reversible perfusion defects.
    • This LV dysfunction can also be observed on delayed gated SPECT, albeit with a lower incidence.
    • Early quantitative gated SPECT effectively identifies transient LV dysfunction following adenosine stress in patients with reversible defects.