[Right and left ventricular ejection fraction evaluation in patients with chronic pulmonary disease. Comparison of...

Our aim was to evaluate right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) in patients with chronic pulmonary disease (CPD) during a standard 99mTc-isonitrilium myocardial perfusion study. Forty patients (14 women and 26 men, mean age 67.7 +/- 7 years old) suffering from CPD enrolled in this study. Patients were consecutively submitted to: a) First pass (FP) angiocardiography with 99mTc (Tauc-FP). b) Multigated angiocardiography (MUGA). c) FP with 99mTc-sestamibi (MIBI-FP). d) Gated FP (MIBI-gFP) and GatedSPECT was performed in 23 patients. A simple SPECT study was performed to the rest of them. Our results showed: For the RV: RVEF measured by each method: Tauc-FP =49.09+/-8.4%, MUGA =48.51+/-10.6%, MIBI-FP =49.45+/-7.8 % and MIBI-gFP =52.49+/-6.05%. No difference among these methods was noted (P=0.674). MIBI-FP ejection fraction range was wider than MIBI-gFP and narrower than MUGA. A strong correlation (r=0.88 P<0.01) and good agreement was found between MIBI-gFP and MIBI-FP. Less strong correlation was estimated between not only Tc-FP and MUGA (r=0.76 P<0.01) but MIBI-FP and MUGA (r=0.68 P<0.01) as well with no sufficient agreement. For the LV: LVEF was also measured by each method: Tauc-FP=61,1+/-8,5%, MUGA=61,2+/-10%, MIBI-FP=61,8+/-6%,EF GSPECT=60,2+/-7%. There was a strong correlation (r=0.87 P<0.01) with good agreement between Tauc-FP and MUGA. For all patients, correlation between MIBI-FP and GSPECT was weak (r=0.62 P<0.01) but ameliorated by the exclusion of 4 patients with small end diastolic volumes (EDV) (r=0.82 P<0.01). The correlation between MUGA and GSPECT got stronger (r=0.85 P<0.01) by the same exclusion. Finally, a strong correlation (r=0.81 P<0.01) with sufficient agreement was noted between MIBI-FP and MUGA.

For the RV: simple or gated FP are reliable with good agreement methods of RVEF evaluation in patients with CPD that can easily be performed during every radionuclide isonitrilium myocardial perfusion study. MUGA is proved to be comparative to the FP estimation of RV EF. The gFP affords the narrowest range of RVEF calculated, allowing the more accurate functional identification of RV borders. For the LV: FP (with 99mTc or with sestamibi-99mTc) is a reliable method of LVEF measurement in patients with CPD when compared with MUGA. MuIotaBetaIota-FP can evaluate LVEF during a standard myocardial perfusion study with radionuclide isonitrilium. GSPECT-EF correlation with EF measured by MUGA or FP is strongly affected by EDV.