Value of gated SPECT in the analysis of regional wall motion of the interventricular septum after coronary artery bypass grafting

Giubbini, Raffaele; Rossini, Pierluigi; Bertagna, Francesco; Bosio, Giovanni; Paghera, Barbara; Pizzocaro, Claudio; Canclini, S.; Terzi, Arturo; Germano, Guido

doi:10.1007/s00259-004-1569-y

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…Wranne et al (5) suggested that the persistence or disappearance of ASM in the late postoperative period depends on factors such as recovery of right heart function with restoration of tricuspid annular motion, development of retrosternal adhesions, and development of left or right ventricular volume overload. This abnormal cardiac mobility may be related to sternotomy and pericardiotomy with anteromedial translation of the heart during systole (11). …”

Section: Discussionmentioning

confidence: 99%

“…Presence or absence of ASM on cine MRI was determined using qualitative visual and quantitative assessment, and the final diagnosis was made by consensus. Septal wall motion was expressed as endocardial inward movement (in millimeters) from the end-diastolic to the end-systolic phase on cine MRI (11). For qualitative analysis of the ASM, we calculated the average value of regional wall motion in the septal segments (Fig.…”

Section: Methodsmentioning

confidence: 99%

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Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

Choi

Chun

et al. 2010

Korean J Radiol

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ObjectiveTo define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques.Materials and MethodsEighteen patients (mean age, 58 ± 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group.ResultsAll patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1±5.3 mm vs. 14.9±4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8±4.5 mm vs. 2.1±5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89±5.41 vs. -15.41±3.7, p < 0.05)ConclusionAbnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

Choi

Chun

et al. 2010

Korean J Radiol

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“…Therefore, gating appears mandatory to interpret the meaning of defects in myocardial perfusion imaging in patients with left bundle branch block. Similarly, Giubbini et al demonstrated that the combination of functional (in particular wall thickening) and perfusion data obtained from gated SPECT is very effective in order to interpret the meaning of septal wall motion abnormalities in patients submitted to coronary artery bypass grafting and to differentiate between pseudo-paradoxical wall motion caused by heart surgery and paradoxical wall motion in patients with prior anterior myocardial infarction [99].…”

Section: Regional Function and Perfusionmentioning

confidence: 99%

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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Background Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. Discussion This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. Aim Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.

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“…We used wall thickening values in the 20-segment model as an adjunct for asynergy assessment. After intervention, since CABG was included in 17% of cases, septal motion showed abnormality even with good wall thickening [18,19]. We therefore determined that the motion was improved after reperfusion if the percentage of wall thickening was improved to >32%.…”

Section: Analysis For Viability Assessmentmentioning

confidence: 99%

“…Even if some myocardial segments showed severe contractile dysfunction, left ventricular global and regional contractility may recover owing to viable segments. Non-invasive myocardial viability assessment thus has been considered important, and various approaches have been utilized including contractile functional reserve by echocardiography with inotropic stimulation, myocardial perfusion imaging with single-photon emission computed tomography (SPECT) and positron emission tomography with 18 F-fuluorodeoxyglucose (FDG) [1][2][3][4][5][6]. Although FDG may provide better diagnostic ability for detecting potentially reversible myocardial dysfunction, single-photon myocardial perfusion tracers continue to be one of the best convenient choices for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan

Nakajima

Tamaki

Kuwabara

et al. 2008

Eur J Nucl Med Mol Imaging

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Backgrounds Prediction of left ventricular functional recovery is important after myocardial infarction. The impact of quantitative perfusion and motion analyses with gated single-photon emission computed tomography (SPECT) on predictive ability has not been clearly defined in multi-center studies. Methods A total of 252 patients with recent myocardial infarction (n=74) and old myocardial infarction (n=175) were registered from 25 institutions. All patients underwent resting gated SPECT using 99m Tc-MIBI, and repeated the study after revascularization after an average follow-up period of 132±81 days. Visual and quantitative assessment of perfusion and wall motion were performed in 5040 segments. Results Non-gated segmental %uptake and end-systolic (ES) %uptake were good predictors of wall motion recovery and significantly differed between improved and non-improved groups (66±17% and 55±18%, p<0.0001 for non-gated, 64±16% and 51±17% for ES %uptake, p<0.0001). The area under the curve (AUC) of receiver-operating characteristics curve (ROC) for non-gated %uptake, ES %uptake, end-diastolic (ED) %uptake and visual perfusion defect score was 0.70, 0.71, 0.61 and 0.56, respectively. Sensitivity and specificity of %uptake were 68% and 64% for non-gated map and 80% and 52% for ES %uptake map. An optimal threshold for predicting segmental improvement was 63% for non-gated and 52% for ES %uptake values. Conclusion Segmental 99m Tc-MIBI uptake provided a useful predictor of wall motion improvement. Application of quantitative approach with non-gated and ES %uptake enhanced predictive accuracy over visual analysis particularly in a multi-center study.

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Value of gated SPECT in the analysis of regional wall motion of the interventricular septum after coronary artery bypass grafting

Abstract: Gated SPECT with perfusion tracers can reliably differentiate pseudo-paradoxical from true paradoxical septal motion in patients with previous CABG, and it may be the method of choice for evaluating left ventricular performance in this patient population.

Cited by 13 publications

References 12 publications

Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan

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