Postischemic Stunning Can Affect Left Ventricular Ejection Fraction and Regional Wall Motion on Post-Stress Gated Sestamibi Tomograms

Johnson, Lynne L.; Verdesca, Stephen A.; Aude, Wady; Xavier, Rosana; Nott, Lorraine; Campanella, Michael W; Germano, Guido

doi:10.1016/s0735-1097(97)00388-4

Cited by 278 publications

(147 citation statements)

References 18 publications

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“…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.…”

Section: Discussionmentioning

confidence: 47%

“…According to the model of myocardial stunning, stressinduced ischaemia may cause wall motion abnormalities or a decrease in the left ventricular (LV) ejection fraction (EF) that may be detected by comparing resting and post-stress gated single photon emission computed tomography (SPECT) [1]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

Dona

Massi

Settimo

et al. 2010

Eur J Nucl Med Mol Imaging

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Purpose The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. Methods We prospectively enrolled 57 consecutive patients with post-stress EF drop ≥5 EF units and summed difference score (SDS)≤1. They were followed up for more than 1 year and their outcome was compared with a group of sex-and agematched controls with the same SDS but without EF decrease. Results During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p<0.0001) between the event-free survival curves of the two groups. ConclusionThe event rate of patients with post-stress EF decrease≥5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

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

Dona

Massi

Settimo

et al. 2010

Eur J Nucl Med Mol Imaging

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“…It must also be considered that the admission ejection fraction was measured after PCI and therefore some degree of very early improvement could already have been present (although this is quite unlikely), and might have affected the relationship with the perfusion defect size that was present at the time of tracer injection. Furthermore, an influence of myocardial stunning or subendocardial ischaemia in producing an apparent decrease in tracer uptake through the partial volume effect cannot be excluded [29]. It must be borne in mind, however, that gated SPECT was always acquired after a resting injection in our series, and that other data suggest that gating does not have a major influence on the infarct size assessment [30].…”

Section: Discussionmentioning

confidence: 87%

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Leoncini

Bellandi

Sciagrà

et al. 2004

Eur J Nucl Med Mol Imaging

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Abstract.Purpose: Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI. Methods: In 36 patients, treated with abciximab, primary PCI and stenting, 99m Tc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined. Results: Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%±11% vs 19%±14%, p<0.02) and 30 days (7%±7% vs 16%±12%, p<0.02) and the salvage index was higher at 30 days (77%±22% vs 55%±28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. Enddiastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B. Conclusion: In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery.

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“…Immediately post-stress, left ventricular functional parameters were not considered due to possible stunned myocardium in severely ischemic patients, a factor which can reduce measured LVEF by more than 5%. 16 The advantage of 3 to 4 hours post-stressTl-201 gated SPECT is that the potential stunning of the myocardiumhas already disappearedin most patients.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Ejection Fraction Assessment by Tl‐201 Gated SPECT: A Comparison With Echocardiography

Harpaz

Asman

Kuperstein

et al. 2010

Clinical Cardiology

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Background: Few studies including only a limited number of patients have compared left ventricular ejection fraction (LVEF) assessed by 2-dimensional echocardiography (2-DE) and electrocardiography-gated Tl-201 single-photon emission computed tomography (SPECT). Hypothesis: LVEF assessment by Tl-201 gated spect is comparable with LVEF assessed by 2-DE in two different echocardiographic laboratories. Material and Methods: Patients (n = 402) underwent Tl-201 gated SPECT in the same laboratory and 2-DE in 2 different laboratories. Patients were divided into 2 groups according to the study laboratory: group 1, at the tertiary hospital and group 2, at a community laboratory. Results: LVEF evaluations were similar (mean LVEF: 50.73%±11.67% by 2-DE vs 50.11%±11.41% by SPECT in group 1 and 57.27%±7.44% by 2-DE vs 57.41%±8.37% by SPECT in group 2). All LVEF measurements were highly correlated (r = 0.7, P<.001). Baseline characteristics differed between the groups, with a higher prevalence of past myocardial infarction in the in-hospital vs the community echo group (46.7% vs 22.2%, P<.01), resulting in a higher LVEF in the latter, both by 2-DE (mean 50.7%±11.7% vs 57.3% ±7.4%, P<.01) and SPECT (50.1%±11.4% vs 57.4%±8.4%, P<.01). Conclusions: The Tl-201 gated SPECT is a reliable clinical tool for LVEF assessment, with good correlation when compared to 2-DE. It may be routinely used as an alternative for patients with poor acoustic visualization and should be performed systematically in patients undergoing myocardial perfusion imaging with Tl-201.

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Postischemic Stunning Can Affect Left Ventricular Ejection Fraction and Regional Wall Motion on Post-Stress Gated Sestamibi Tomograms

Abstract: When the only gated sestamibi scan is the post-stress scan, global and regional LV function will not represent basal LV function in all patients with stress-induced ischemia.

Cited by 278 publications

References 18 publications

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

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

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Left Ventricular Ejection Fraction Assessment by Tl‐201 Gated SPECT: A Comparison With Echocardiography

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