Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization

Abstract

Morbidity and mortality increase when diastolic dysfunction accompanies coronary artery disease (CAD). An elevated stress 201 Tl lung-to-heart ratio (LHR) is a traditional marker of elevated left ventricular end-diastolic pressure (LVEDP), which adds prognostic value in CAD. Since the introduction of 99m Tc-labeled agents, this valuable marker has been lost. Hence, there is only a limited ability to assess diastolic dysfunction by myocardial perfusion imaging (MPI). Methods: Fifty-two consecutive patients with an ejection fraction of $45% underwent MPI and cardiac catheterization within 15 d. Peak filling rate (PFR), time to PFR (TPFR), and filling rate during the first third of diastole (1/3FR) were obtained from MPI with SPECT software. Resting 201 Tl LHR was calculated manually, and LVEDP was obtained at catheterization. Results: PFR, TPFR, and 1/3FR correlated significantly with LVEDP (r 5 20.53, 0.45, and 20.45, respectively; P 5 0.00005, 0.0009, and 0.0009, respectively), whereas resting 201 Tl LHR did not (r 5 0.10, P 5 0.49). Receiver-operatingcharacteristic curve analysis of PFR, TPFR, and 1/3FR for detecting LVEDPs of $18 mm Hg showed areas under the curve of 0.83, 0.75, and 0.80, respectively. The combination of PFR and 1/3FR showed a negative predictive value of 84%, a positive predictive value of 86%, and a specificity of 94%. Conclusion: Diastolic filling variables obtained with the SPECT software showed a significant correlation with LVEDP. PFR, TPFR, and 1/3FR were superior to resting 201 Tl LHR and showed good sensitivity, specificity, and predictive power for detecting LVEDPs of $18 mm Hg. Hence, combining data on the presence of perfusion defects with data on diastolic impairments can be achieved by adding these variables to MPI results.

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