Diagnostic value of left ventricular function after stress and at rest in the detection of multivessel coronary artery disease as assessed by electrocardiogram-gated SPECT

Abstract

The addition of poststress and at-rest LV functional analysis by use of gated SPECT to conventional perfusion analysis helps to better identify patients with multivessel CAD.

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

“…Similarly to increased lung uptake and TID, the presence of a major EF drop after stress is commonly considered as a sign of severe coronary artery disease, but the meaning of a borderline post-stress EF decrease has been recently questioned [1,2,4,6,7]. Conversely, our results indicate that the prognosis of patients with this finding and without inducible ischaemia is significantly worse than in compa- 12 ( rable patients with the same perfusion pattern but with stable EF.…”

“…Because we adopted a relatively low threshold for classifying the EF response as abnormal, the gated SPECT reproducibility is a major issue. However, both literature data and our prior direct experience indicate that in general the reproducibility of gated SPECT is high enough to make the 5% cutoff clinically reliable [6,[22][23][24].…”

“…The patients were prospectively included in the follow-up registry if they showed a ≥5 EF units decrease in poststress images without stress-inducible ischaemia (as below defined) [6,8]. Because the meaning of the EF drop was still under investigation, it was our policy to avoid indicating it in the clinical report.…”

“…For this reason, the presence of a post-stress EF decrease has been indicated as an additional sign of coronary artery disease (CAD) severity, like increased tracer lung uptake or transient ischaemic dilatation, which are known to have an adverse prognostic meaning [2][3][4][5][6]. However, a recent study has demonstrated that the poststress EF decrease in patients with inducible ischaemia is usually negligible and that only a very limited percentage of ischaemic patients have a really significant EF decrease [7].…”

Valor diagnóstico da cintilografia miocárdica em pacientes com doença coronariana multiarterial

“…When analyzing poor prognosis criteria, 25 patients (39.1%) were found with a drop in LV ejection fraction (LVEF) higher than 5%, 57 (82.6%) with abnormal systolic thickening in at may evaluate left ventricle (LV) function and detect regional changes in systolic contractility and thickening, increasing the accuracy in the detection of high risk cardiovascular disease [11][12][13] . Our hypothesis is that gated-SPECT MPRI has great sensitivity in detecting patients with multiple vessel territories.…”