Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

Jeong, Hwan-Jeong; Lee, Dong Hoon; Lee, Ho‐Young; Sw, Choi; Han, Young Jin; Chung, June‐Key

doi:10.1007/s13139-013-0213-9

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…Wall thickening was graded using the 4-point scoring system (0-normal, 1-mild, 2-moderate to severe, 3-absent) ( 12 , 21 ). The scores of the 17 segments were added up to obtain the summed motion score (SMS) and summed thickening score (STS), respectively ( 13 ).…”

Section: Methodsmentioning

confidence: 99%

“…SMS can be considered as an independent prognostic factor in the risk stratification of patients with suspected CAD ( 12 ). SMS can also be used as a predictor of cardiac events and have a value for clinical risk stratification of diabetic patients with normal perfusion ( 13 ). However, to date, there is no report documenting the value of SMS in predicting the prognosis of DCM.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

Zhu

Wang

Huang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe prognosis of patients with dilated cardiomyopathy (DCM) is poor and new indicators are urgently needed to predict lethal cardiac events. This study aimed to investigate the value of summed motion score (SMS) in predicting cardiac death of DCM patients using gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).Methods and resultsEighty-one patients with DCM who underwent 99mTc-MIBI gated SPECT MPI were retrospectively enrolled and were divided into cardiac death and survivor groups. The functional parameters of left ventricle including SMS were measured using quantitative gated SPECT software. During the follow-up period of 44 (25, 54) months, 14 (17.28%) cardiac deaths were observed. Compared with the survivor group, SMS was significantly higher in the cardiac death group. Multivariate cox regression analysis showed that SMS was an independent predictor for cardiac death (HR 1.34, 95% CI 1.02–1.77, P = 0.034). SMS also provided incremental prognostic value over other variables in the multivariate model as determined by likelihood ratio global chi-squared test. In the Kaplan-Meier survival analysis, the event-free survival rate was significantly lower in the high-SMS (HSMS) group than the low-SMS (LSMS) (log-rank P < 0.001). Furthermore, the area under curve (AUC) of SMS was larger than that of LVEF at the 12th month of follow-up (0.85 vs. 0.80, P = 0.045).ConclusionSMS is an independent predictor of cardiac death in DCM patients and provides incremental prognostic value. SMS might have higher predictive value than LVEF for early cardiac death.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

Zhu

Wang

Huang

et al. 2023

Front. Cardiovasc. Med.

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“…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.…”

Section: See Related Article Pp 742-753mentioning

confidence: 99%

“…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.…”

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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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“…As a result, early diagnosis of patients at risk is important in preventing cardiac events. [ 1 ] In patients with DM, left ventricular (LV) diastolic dysfunction is an early finding of cardiomyopathy and reportedly may be accompanied by increased cardiac mortality. [ 2 ] In patients with clinically asymptomatic DM and normal systolic function, it is thus important to identify diastolic function disorders in the early period.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of diastolic function in patients with normal perfusion and type 2 diabetes mellitus with gated single-photon emission computed tomography

2017

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Early identification of diastolic dysfunction of patients with diabetes is important in preventing cardiac events. In this study, we aimed to show that both myocardial perfusion and diastolic function parameters can be evaluated in diabetic patients with possible silent cardiac symptoms using gated single-photon emission computed tomography (G-SPECT). We examined eighty patients: Forty with and forty without diabetes. The patients were compared in terms of systolic and diastolic parameters obtained using G-SPECT. 99mTc-sestamibi was used to obtain 8-frame images in each cardiac cycle, with calculation of the left ventricular ejection fraction (LVEF), peak filling rate (PFR), mean filling rate during the first third of diastolic time (MFR/3), and time to peak filling (TTPF) using the QGS software. G-SPECT results were compared in forty diabetic and forty nondiabetic patients of similar age and sex. Of the diastolic function parameters, PFR was found to be lower in patients with than without diabetes (2.31 ± 0.68 vs. 2.76 ± 0.68, respectively; P = 0.004). The TTPF and MFR/3 in both groups were similar. PFR was negatively correlated with end-diastolic volume and end-systolic volume (ESV) and positively correlated with LVEF. This correlation was stronger in patients with diabetes. The diastolic parameter PFR, obtained using G-SPECT, was significantly lower in patients with than without diabetes. We believe that these parameters should be noted for the early diagnosis or prevention of heart disease in patients with a risk of diastolic dysfunction.

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Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

Abstract: The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.

Cited by 7 publications

References 26 publications

Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

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

Evaluation of diastolic function in patients with normal perfusion and type 2 diabetes mellitus with gated single-photon emission computed tomography

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