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Evaluation of left ventricular performance in infants and children using radionuclide angiography
Insights
Quantitative first-pass radionuclide angiography accurately assesses left ventricular function in pediatric cardiomyopathy. This method effectively evaluates global and regional left ventricular ejection fraction and wall motion in children with heart failure.
Area of Science:
- Pediatric Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Pediatric cardiomyopathy presents with diverse clinical manifestations, including congestive heart failure.
- Accurate assessment of left ventricular (LV) function is crucial for managing pediatric heart failure.
- Non-invasive imaging techniques are vital for evaluating LV function in pediatric patients.
Purpose of the Study:
- To evaluate the utility of quantitative first-pass radionuclide angiography (FP-RNA) in assessing regional and global LV function in children with cardiomyopathy.
- To compare FP-RNA derived parameters with echocardiography and contrast angiography.
Main Methods:
- Eight FP-RNA studies were performed in seven pediatric patients (3 months to 15 years) with cardiomyopathy and congestive heart failure.
- Echocardiography was performed within 24 hours of FP-RNA.
- LV ejection fraction (LVEF), regional ejection fraction index (REFI), and LV wall motion were analyzed.
- FP-RNA data were compared with echocardiographic and contrast angiographic findings.
Main Results:
- FP-RNA accurately depicted reduced LVEF (23-44%) in patients with non-obstructive cardiomyopathy and normal LVEF (79%) in obstructive cardiomyopathy.
- Regional analysis revealed diffuse hypokinesis in non-obstructive cases and hyperdynamic motion in the obstructive case.
- FP-RNA derived parameters correlated favorably with echocardiography and contrast angiography.
Conclusions:
- Quantitative FP-RNA is a reliable, non-invasive method for assessing global and regional LV function in pediatric cardiomyopathy.
- FP-RNA provides valuable insights into myocardial contractility and wall motion abnormalities in children with heart failure.
- This technique aids in the diagnosis and management of pediatric cardiovascular conditions.
Abstract:
Eight quantitative first-pass (FP) radionuclide angiograms were performed in six children with left ventricular (LV) dysfunction without associated LV outflow obstruction and one infant with obstructive cardiomyopathy (CM) to define regional and global LV function. All patients (3 months to 15 years) had clinical findings of congestive heart failure. Echocardiographic evaluation was performed within 24 hours of the FP study. LV ejection fraction (LVEF), regional ejection fraction index (REFI), LV wall motion perimeters, transit time, and curve analysis were evaluated. Ejection fraction by FP-RNA was compared to echo in all patients. FP-RNA derived end-diastolic and end-systolic LV perimeters were compared to corresponding contrast angiographic definition of LV wall boundaries. FP-LVEF ranged from 23-44% in 6 patients with non-obstructive CM and was 79% in 1 patient with obstructive CM. REFI revealed diffuse hypokinesis in 6 patients with nonobstructive CM, with additional apical akinesis in 1 patient. The infant with obstructive CM had hyperdynamic wall motion. These data compared favorably with echo EF and angiographic assessment of LVEF and wall motion.