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Assessment of diastolic heart function--experience with 16-gated myocardial perfusion SPECT
R D Lele1, Karuna Luthra, Yogini Sawant
1Department of Nuclear Medicine, Lilavati Hospital and Research Centre, Mumbai.
Insights
Myocardial perfusion imaging (MPI) effectively assesses cardiac function, detecting diastolic dysfunction early in suspected coronary artery disease (CAD) patients. This non-invasive approach guides management and prevents unnecessary invasive procedures.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Ischaemic heart disease (IHD) remains a significant global health concern.
- Current diagnostic focus often emphasizes epicardial stenosis and surgical interventions, potentially overlooking early cardiac functional impairments.
- Diastolic dysfunction, an early indicator of cardiac issues, is frequently undetected in routine evaluations.
Purpose of the Study:
- To evaluate the utility of 16-gated SPECT myocardial perfusion imaging (MPI) in assessing cardiac function, particularly diastolic dysfunction, in patients with suspected coronary artery disease (CAD).
- To determine if MPI can provide comprehensive functional assessment beyond perfusion, aiding in patient management and symptom correlation.
Main Methods:
- 121 patients with suspected CAD underwent gated myocardial perfusion imaging (MPI) using SPECT-CT with attenuation correction.
- Diastolic function was assessed using 16-gated SPECT MPI data.
- Image quality was enhanced by SPECT-CT attenuation correction.
Main Results:
- MPI revealed no inducible ischaemia in 60% of patients, avoiding further invasive procedures.
- 40% of patients demonstrated inducible ischaemia, necessitating further evaluation and intervention.
- Among all patients, 10% exhibited both left ventricular (LV) systolic and diastolic dysfunction.
- A significant finding was that 66% of patients had isolated diastolic dysfunction.
- Notably, 40% of patients with normal systolic function and no ischaemia presented with symptoms like chest heaviness or angina equivalents, linked to diastolic dysfunction.
Conclusions:
- Gated myocardial perfusion imaging (MPI) is a valuable tool for evaluating suspected coronary artery disease (CAD).
- Beyond assessing perfusion, MPI provides crucial functional insights into both systolic and diastolic cardiac function.
- This comprehensive functional data aids in understanding patient symptomatology and informs clinical management decisions, potentially preventing unnecessary invasive procedures.
Background:
Ischaemic heart disease (IHD) is a major health problem today. However the focus has shifted primarily to angiographically detecting epicardial vessel stenoses, and ways and means of surgically correcting the blocks. Patients are often not fully evaluated for cardiac function, and diastolic dysfunction of heart, which is often an earlier manifestation than systolic dysfunction, goes undetected.
Methods:
Recent gamma cameras have better imaging quality due to attenuation correction with SPECT-CT. 121 patients underwent gated myocardial perfusion imaging (MPI) for suspected coronary artery disease (CAD). We studied the diastolic function of these patients by 16-gated SPECT MPI.
Results:
60% patients showed absence of inducible ischaemia on MPI, and hence further invasive procedures like angiography were prevented, 40% showed inducible ischaemia and had to be further evaluated and required intervention. Of all 121 patients, 10% had LV systolic and diastolic dysfunction whereas 66% had isolated diastolic dysfunction. 40% patients had no ischaemia, normal systolic function and only diastolic dysfunction. 40% of these cases had symptoms of chest heaviness/angina equivalent.
Conclusion:
Myocardial perfusion imaging is a useful modality for evaluating patients of suspected CAD and in addition to perfusion data, also provides functional assessment of systolic and diastolic function, which provides comprehensive information regarding patients' symptomatology and can guide further management.
