Radionuclide Imaging Findings in Iatrogenic Stress in Cases with Reduced Left Ventricular Ejection Fraction
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Abstract
Objective: This study aims to contribute to the existing literature by assisting in the selection of stress protocols for patients with reduced left ventricular ejection fraction (LVEF). We also aim to provide insights into patient follow-up based on changes in post-stress LVEF determined by echocardiography.
Methods: Our retrospective study encompassed 487 patients initially diagnosed with coronary artery disease. Left ventricular function was assessed using echocardiography and myocardial perfusion scintigraphy. Among them, 250 patients with LVEF values within normal limits constituted Group-1, while 237 patients with LVEF values below 50% formed Group-2. Exercise stress testing was performed using a treadmill according to the Bruce protocol. For vasodilator stress testing, intravenous adenosine infusion at a rate of 140 μg/kg/min was administered for 6 minutes. Tc-99m-sestamibi was intravenously administered (8-12 mCi) for stress imaging and (24-36 mCi) for rest imaging.
Results: The median age of all patients in the study was 64 (52-79) years, with 283 (58.1%) being male. Myocardial perfusion, assessed by myocardial perfusion scintigraphy, revealed a fixed perfusion defect in all patients. Reversible perfusion defects were observed in 172 (35.3%) patients. Among patients with reduced echo-LVEF values, those who underwent exercise stress testing showed significantly lower post-stress EF values compared to those who underwent vasodilator stress testing (35 (25-42) vs. 36 (30-47), p: 0.0005). Post-stress LVEF was notably lower in patients with reversible perfusion defects, indicating a higher rate of LVEF decrease due to stress (p: 0.0005).
Conclusion: Left ventricular ejection fraction (LVEF) serves as a valuable metric for assessing left ventricular function. The findings from this study support its utility in guiding the selection of a suitable stress protocol and monitoring patients during iatrogenic cardiac stress applications.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2024-01-30
Published 2024-02-04
References
Wood PW, Choy JB, Nanda NC, Becher H. Left ventricular ejection fraction and volumes: it depends on the imaging method. Echocardiography 2014;31:87–100. DOI: https://doi.org/10.1111/echo.12331
Dorosz JL, Lezotte DC, Weitzenkamp DA, Allen LA, Salcedo EE. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012;59:1799–1808. DOI: https://doi.org/10.1016/j.jacc.2012.01.037
Dorbala S, Ananthasubramaniam K, Armstrong IS, et al. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol [Internet] Springer US 2018;25:1784-1846. DOI: https://doi.org/10.1007/s12350-018-1283-y
Daly P, Kayse R, Rudick S, et al. Feasibility and safety of exercise stress testing using an anti-gravity tredmill with Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) myocardial perfusion imaging: A pilot non-randomized controlled study. J Nucl Cardiol 2018;25:1092-1097. DOI: https://doi.org/10.1007/s12350-017-1045-2
Rubeaux M, Xu Y, Germano G, et al. Normal Databases for the Relative Quantification of Myocardial Perfusion. Curr Cardiovasc Imaging Rep 2016;9:22. DOI: https://doi.org/10.1007/s12410-016-9385-x
Gowdar S, Chaudhry W, Ahlberg AW, et al. Triage of patients for attenuation-corrected stress-first Tc-99m SPECT MPI using a simplified clinical pre-test scoring model. J Nucl Cardiol 2018;25:1178-1187. DOI: https://doi.org/10.1007/s12350-017-0832-0
Canbaz Tosun F, Ozdemir S, Sen F et al. Myocardial Perfusion SPECT Procedure Guideline. Nucl Med Semin 2020;6:90-134 DOI: https://doi.org/10.4274/nts.galenos.2020.0010
Thavendiranathan P, Popovi_c ZB, Flamm SD, Dahiya A, Grimm RA,Marwick TH. Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images. J Am Soc Echocardiogr 2013;26:1267–1273. DOI: https://doi.org/10.1016/j.echo.2013.07.017
Kliner D, Wang L, Winger D, Follansbee WP, Soman P. A prospective evaluation of the repeatability of left ventricular ejection fraction measurement by gated SPECT. J Nucl Cardiol 2015;22:1237–1243. DOI: https://doi.org/10.1007/s12350-015-0071-1