Relation of exercise Doppler left ventricular filling to thallium lung uptake

Finkelhor, Robert S.; Ramer, Cindy L.; Castellanos, Miguel; Miron, Stefan D.; Teague, Steve M.

doi:10.1016/0002-8703(93)90070-p

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…9,13,14 A close correlation between Doppler-derived diastolic function and invasively-derived hemodynamic parameters has been reported by several authors. [13][14][15] Finkelhor et al 14 correlated peak E-and peak A-wave velocities with L/H in 56 patients undergoing exercise perfusion scintigraphy: higher E-wave velocities were observed in patients with high L/H values. In the present study, severe mitral regurgitation and peak A-wave velocity were the sole independent predictors of increased 201 Tl lung uptake, and a significant inverse linear relation between L/H and A was found.…”

Section: Lung 201 Tl Uptake and Diastolic Functionsupporting

confidence: 63%

Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

et al. 2000

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Section: Lung 201 Tl Uptake and Diastolic Functionsupporting

confidence: 63%

Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

et al. 2000

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“…Elevated stress 201 Tl lung uptake during myocardial perfusion imaging (MPI) reflects left ventricular diastolic dysfunction. Studies have shown that increased stress 201 Tl lung uptake correlates well with increased left ventricular filling pressure (4)(5)(6)(7). Hence, an increased stress 201 Tl lungto-heart ratio (LHR) identifies diastolic dysfunction, which can be considered in combination with the presence of perfusion defects.…”

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confidence: 99%

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

Patel¹,

Robinson²,

Arteaga³

et al. 2008

J Nucl Med

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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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Thallium-201 right lung/heart ratio during exercise in patients with coronary artery disease: relation to thallium-201 myocardial single-photon emission tomography, rest and exercise left ventricular function and coronary angiography

Morel

Pézard

Furber

et al. 1999

European Journal of Nuclear Medicine and Molecular Imaging

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The aim of this study was to correlate lung thallium-201 uptake on exercise with 201Tl single-photon emission tomography (SPET) myocardial perfusion imaging, rest and exercise equilibrium radionuclide angiographic and coronary angiographic findings in patients with coronary artery disease (CAD) using a simple, reproducible lung/heart (L/H) ratio that would be easy to use in clinical practice. L/H ratio was defined on the anterior planar image obtained during exercise 201Tl SPET acquisition as the mean counts per pixel in an entire right lung field region of interest divided by the mean counts per pixel in the hottest myocardial wall region of interest. We studied 103 patients. Fifty-nine patients (group I) with <5% likelihood of CAD were used as a reference group. In 44 CAD patients (group II), L/H ratio was compared with 201Tl SPET, radionuclide angiographic and coronary angiographic variables. The group I L/H ratio of 0.35+/-0.05 (mean +/-1 SD) was significantly lower (P<0.001) than the group II L/H ratio of 0. 45+/-0.10. An L/H ratio >0.45 (mean + 2 SD in group I) was considered abnormal. In group II, L/H ratio showed a significant correlation with stress and rest 201Tl perfusion defect size (r = 0. 39 and r = 0.42, P<0.01, respectively), but not with extent of ischaemic myocardium. The mean L/H ratio was 0.41+/-0.10 in patients with one-vessel disease (n = 15), 0.46+/-0.08 in those with two-vessel disease (n = 17) and 0.47+/-0.12 in those with three-vessel disease (n = 12), but no significant difference was found between the three subgroups. L/H ratio showed a significant inverse relation with rest and exercise left ventricular ejection fraction (r = -0.37 and r = -0.50, P<0.05 and P<0.001, respectively). Using stepwise multiple regression analysis, exercise left ventricular ejection fraction and previous history of hypertension were the sole two variables independently predictive of the L/H ratio. In conclusion, although lung thallium uptake is usually found to correlate with extent and severity of CAD, increased L/H ratio should primarily be considered as a marker of exercise-induced left ventricular systolic and perhaps diastolic dysfunction, probably independent of the underlying cardiac disease.

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Relation of exercise Doppler left ventricular filling to thallium lung uptake

Cited by 4 publications

References 30 publications

Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

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

Thallium-201 right lung/heart ratio during exercise in patients with coronary artery disease: relation to thallium-201 myocardial single-photon emission tomography, rest and exercise left ventricular function and coronary angiography

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Relation of exercise Doppler left ventricular filling to thallium lung uptake

Cited by 4 publications

References 30 publications

Independent and Incremental Prognostic Value of 201 Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

Independent and Incremental Prognostic Value of 201 Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

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

Thallium-201 right lung/heart ratio during exercise in patients with coronary artery disease: relation to thallium-201 myocardial single-photon emission tomography, rest and exercise left ventricular function and coronary angiography

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Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction

Independent and Incremental Prognostic Value of ²⁰¹ Tl Lung Uptake at Rest in Patients With Severe Postischemic Left Ventricular Dysfunction