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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

Published on: February 16, 2016

Diagnostic and prognostic value of gated myocardial perfusion single-photon emission computed tomography in low-risk

Laura Evangelista1, Luca Nai Fovino, Francesca Saladini

  • 1Radiotherapy and Nuclear Medicine Unit, Medical Clinic IV, University of Padua, Padova, Italy.

Nuclear Medicine Communications
|January 21, 2012
PubMed

Insights

Gated single-photon emission computed tomography (SPECT) reveals significant differences in myocardial perfusion and ventricular volumes between patients with and without left bundle-branch block (LBBB). These findings impact risk stratification and prognosis in LBBB patients.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Diagnostic Imaging

Background:

  • Left bundle-branch block (LBBB) complicates myocardial perfusion imaging, reducing the accuracy of coronary artery disease (CAD) risk assessment.
  • Abnormal left ventricular activation in LBBB can cause perfusion defects, mimicking CAD.
  • Gated single-photon emission computed tomography (SPECT) is a valuable tool for assessing cardiac function and perfusion.

Purpose of the Study:

  • To evaluate the diagnostic and prognostic value of gated SPECT in low-risk patients with LBBB.
  • To compare myocardial perfusion and ventricular function parameters between patients with and without LBBB.
  • To identify potential early markers of diastolic dysfunction in LBBB patients.

Main Methods:

  • 114 patients underwent Tc-99m sestamibi gated SPECT, divided into groups with (n=57) and without (n=57) LBBB.
  • Coronary angiography was performed, and patients were stratified for CAD risk.
  • Quantified SPECT parameters included summed stress score, summed rest score, summed difference score, end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF).
  • Mean variations in EDV and ESV (rest minus post-stress) were calculated.
  • Cardiac events were tracked over a mean follow-up of 32 months.

Main Results:

  • Gated SPECT positivity was significantly higher in LBBB patients (58%) compared to non-LBBB patients (14%) (P<0.001).
  • LBBB patients exhibited higher summed stress scores, EDV, and ESV.
  • A significant increase in EDV was observed in LBBB patients from rest to post-stress (1.32 ml vs. -2.21 ml in non-LBBB, P<0.05).
  • Cardiac events occurred more frequently in LBBB patients (35% vs. 12%, P<0.01) over follow-up.

Conclusions:

  • Gated SPECT reveals distinct functional and perfusion differences between patients with and without LBBB.
  • In LBBB patients, a decrease in EDV from rest to post-stress may indicate early diastolic dysfunction.
  • This diastolic dysfunction marker could predict reduced LVEF and impact patient prognosis.
Abstract

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