Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

Sotgia, Barbara; Sciagrà, Roberto; Parodi, Guido; Kastrati, Adnan; Antoniucci, David; Schömig, Albert; Pupi, Alberto

doi:10.1007/s00259-007-0663-3

Cited by 13 publications

(13 citation statements)

References 25 publications

(24 reference statements)

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“…The wall thickening salvage index was: extent of wall thickening abnormalities in post-treatment gated SPECT minus perfusion defect extent in post-treatment gated SPECT divided by extent of wall thickening anomalies in posttreatment gated SPECT. 13 …”

Section: Discussionmentioning

confidence: 99%

“…16 Previous data indicate a good reproducibility of these visual estimates in our laboratory. 17 The segments with abnormal scores (scores 2-4 for perfusion and scores 1-3 for wall thickening) 13 were identified and the abnormalities were expressed as percent extent of the polar maps. Therefore, the extent of any abnormality (perfusion or wall thickening) was: number of abnormal segments 17 Â 100…”

Section: Discussionmentioning

confidence: 99%

“…13 Although the results appeared promising, that patient population was not representative of the patients currently submitted to primary percutaneous coronary intervention (PCI) for AMI, because included patients only admitted very late after symptom onset and who in part underwent just spontaneous reperfusion. Therefore, we performed the present study to verify the accuracy of our approach in the correct clinical setting of patients treated by primary PCI early after AMI onset.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of an accurate assessment of myocardial salvage by comparing functional and perfusion abnormalities in post-reperfusion gated SPECT

Sciagrà

Dona

Coppola

et al. 2010

Journal of Nuclear Cardiology

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Background. Because of persistent stunning, post-treatment functional abnormalities could identify the initial risk area. The study aims to detect myocardial salvage using postrevascularization gated SPECT in acute myocardial infarction (AMI) treated by reperfusion therapy.Methods. In 36 AMI patients, we performed a first gated SPECT injecting 99mTc-sestamibi before primary percutaneous coronary intervention (PCI), and a second 5 days later. The salvage index defined by the two perfusion images was compared with the value obtained by subtracting in the second gated SPECT the extent of perfusion defect from the extent of wall thickening abnormalities.Results. The wall thickening salvage index correlated with the reference perfusion salvage index (Spearman's q 5 .92, P < .0001), with a 95% limit of agreement 5 ±.25. The agreement between the classifications in salvage index tertiles of the reference and of the wall thickening salvage index was good (kappa 5 .75). All patients with optimal PCI result and 18/24 of those with intermediate or poor outcome were correctly classified.Conclusions. Comparing function and perfusion in a single post-PCI 99m Tc-sestamibi gated SPECT it is possible to estimate myocardial salvage. This could have useful implications in studies comparing different treatment strategies for AMI. (J Nucl Cardiol 2010;17:825-30.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of an accurate assessment of myocardial salvage by comparing functional and perfusion abnormalities in post-reperfusion gated SPECT

Sciagrà

Dona

Coppola

et al. 2010

Journal of Nuclear Cardiology

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“…In the routine analysis of clinical studies, the assessment of LV volumes and ejection fraction (EF) has important implications for the prediction of patient outcome (8). The assessment of regional wall motion (WM) or wall thickness (WT), when combined with perfusion data, has proven useful for tissue characterization (9) and prediction of segment recovery (10,11). Recently, a new acquisition technology has emerged, combining semiconductor cadmium-zinc-telluride (CZT) detectors with higher count sensitivity, a new camera geometry, and new reconstruction algorithms (12).…”

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confidence: 99%

Absolute Quantification of Left Ventricular Global and Regional Function at Nuclear MPI Using Ultrafast CZT SPECT: Initial Validation Versus Cardiac MR

et al. 2013

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We sought to evaluate the accuracy of myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) SPECT cameras for the measurement of left ventricular (LV) global and regional function, and the performance of absolute wall motion (WM) and wall thickness (WT) measurements for the detection of myocardial scarring, using cardiac MR as a reference. Methods: Sixty patients with known or suspected coronary artery disease underwent MPI using a CZT SPECT camera, as well as cine and delayed enhanced cardiac MR. Gated MPI data were processed using quantitative gated SPECT software. LV global function was assessed by measuring LV end-diastolic volume (EDV), endsystolic volume (ESV), and ejection fraction (EF). Regional function was assessed by quantifying segmental WM and WT according to the 17-segment model. Myocardial scarring was quantified on each segment using delayed enhanced cardiac MR. Agreement between SPECT and cardiac MR was assessed using Pearson correlation and Bland-Altman analyses. The influence of measurement magnitude on the agreement was analyzed using Spearman correlation coefficients between the mean and SD of measurements. The performance of WM and WT for the detection of segments with more than 25% scar transmurality was assessed using receiver-operating-characteristic analysis. Results: Correlation between methods was excellent for EF (R 5 0.81, P , 0.0001) and ESV (R 5 0.88, P , 0.0001) and was good for EDV (R 5 0.71, P , 0.0001). Agreement was good for EF (bias, 22.7%; limits of agreement, 215.5 to 110.1) but was lower for EDV (bias, 229.7 mL; limits of agreement, 268.3 to 18.9) and ESV (bias, 29.9 mL; limits of agreement, 230.7 to 110.9). Correlation between methods was fair for WM (R 5 0.49, P , 0.0001) and WT (R 5 0.48, P , 0.0001). SPECT underestimated WT (bias, 241%; limits of agreement, 2108 to 126), with an error depending on thickening magnitude (r 5 0.70, P , 0.0001). The agreement in WM measurement was higher (bias, 21.4 mm; limits of agreement, 26.9 to 14) and independent of motion magnitude (r 5 0.006, P 5 0.86). WM and WT were equally able to identify scarred segments (area under the receiver-operating-characteristic curve, 0.74 6 0.03 and 0.74 6 0.03, respectively). Conclusion: MPI using CZT SPECT cameras and quantitative gated SPECT analysis accurately quantifies EF but still underestimates LV volumes. WM shows a higher agreement with cardiac MR than does WT, with errors in WT measurement increasing at greater thicknesses. Absolute quantification of segmental WM and WT can equally be used to identify myocardial scarring.

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“…Others demonstrated the usefulness of wall thickening in addition to perfusion in the assessment of post-MI myocardial salvage, which might have implications in the prediction of LV remodeling. 12 Further assessment of the value of STS and abnormal remote thickening in predicting future LV enlargement and remodeling might illuminate this issue.…”

Section: See Related Article Pp 742-753mentioning

confidence: 99%

What is the value of motion and thickening in gated myocardial perfusion SPECT?

Sharir

2018

Journal of Nuclear Cardiology

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Myocardial perfusion SPECT imaging (MPI) is a stress imaging modality, widely used in the detection and evaluation of coronary artery disease (CAD). This method is unique in providing simultaneous bi-modal functional imaging of relative myocardial perfusion and left ventricular (LV) function.1 While perfusion images identify regions with relative hypoperfusion, gated SPECT allows assessment of global and regional LV function. The added prognostic information gained by global LV function to myocardial perfusion findings has been extensively shown.2,3 However, accurate regional assessment of contractile function is also of great importance, since it could enhance the detection of CAD, 4 and provide additional prognostic information in predicting cardiac events. 5,6 Similar to myocardial perfusion, regional motion and thickening can be assessed using semi-quantitative visual methods, based on segmental scoring. While motion score simply reflects the extent of inward shift of the ventricular wall, thickening is assessed as systolic brightening of the myocardium occurring due to the partial volume effect. This systolic apparent increase in count density occurs since myocardial thickness is commonly in the range up to 2 cm, less than twice the full width at half maximum of the point spread function of conventional gamma cameras with intrinsic spatial resolution of *1 cm.7 Visual assessment of regional LV contractile function is expert dependent, and suffers from limited reproducibility with high inter-and intraobserver variability. 8 Therefore, several methods have been developed and validated, which automatically quantify motion and thickening, and provide useful and reproducible assessment of regional function.9,10 Whether visually or automatically assessed, regional motion and thickening have been shown as important adjunctive parameters to perfusion in the diagnosis of CAD.In the current issue of the Journal of Nuclear Cardiology, Yang et al. used resting gated SPECT MPI to demonstrate the relationship between myocardial thickening and LV remodeling among patients with history of myocardial infarction (MI). The 92 patients included in the analysis were divided into subacute MI (3-6 months before nuclear testing, n = 54) and old MI ([6 months before nuclear testing, n = 38) subgroups. In addition, all patients underwent FDG-PET imaging to identify myocardial viability as metabolic perfusion mismatch, and a scar score was calculated. LV remodeling was defined as end-diastolic volume index [62.53 ml/m 2 , derived as mean value ?2 standard deviations from gated SPECT of another 95 patients who had normal SPECT MPI and no evidence of CAD. Compared to patients with subacute MI, those with old MI had larger LV volume and worse cardiac function, larger perfusion deficit, and higher summed thickening score (STS). Interestingly, of all the demographic, clinical, perfusion, and metabolic imaging parameters evaluated, only the STS and the % of segments with reduced thickening among segments with normal perfusion were independ...

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Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

Cited by 13 publications

References 25 publications

Feasibility of an accurate assessment of myocardial salvage by comparing functional and perfusion abnormalities in post-reperfusion gated SPECT

Feasibility of an accurate assessment of myocardial salvage by comparing functional and perfusion abnormalities in post-reperfusion gated SPECT

Absolute Quantification of Left Ventricular Global and Regional Function at Nuclear MPI Using Ultrafast CZT SPECT: Initial Validation Versus Cardiac MR

What is the value of motion and thickening in gated myocardial perfusion SPECT?

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