重组人脑利钠肽治疗急性心力衰竭临床研究

 目的 评价扩张型心肌病(DCM)伴充血性心力衰竭(CHF )患者接受外源性重组人脑利钠肽(新活素)治疗后血浆心房利钠肽(ANP)和脑利钠肽(BNP)水平的动态变化,探讨外源性给予重组人脑利钠肽(新活素)对心脏内分泌的病理生理影响.方法 88例入选,其中新活素组46例,另42例为对照组 .两组治疗前和治疗3个月后分别以放射免疫测定法和固相免疫测定法测定ANP和BNP.结果 新活素治疗后患者近期症状明显改善,同时血浆ANP、BNP水平显著降低.结论 DCM伴CHF患者接受外源性重组人脑利钠肽治疗后,不仅缓解心衰症状,而且显著改善心脏内分泌功能.这种心脏内分泌变化可能有助于心衰预后.     

Variations in 123I-metaiodobenzylguanidine (MIBG) late heart mediastinal ratios in chronic heart failure: a need for standardisation and validation

Background There is lack of validation and standardisation of acquisition parameters for myocardial ¹²³I-metaiodobenzylguanidine (MIBG). This lack of standardisation hampers large scale implementation of ¹²³I-MIBG parameters in the evaluation of patients with chronic heart failure (CHF). Methods In a retrospective multi-centre study ¹²³I-MIBG planar scintigrams obtained on 290 CHF patients (82% male; 58% dilated cardiomyopathy; New York Heart Association [NYHA classification] > I) were reanalysed to determine the late heart-to-mediastinum ratio (H/M). Results There was a large variation in acquisition parameters. Multivariate forward stepwise regression showed that a significant proportion (31%, p < 0.001) of the variation in late H/M could be explained by a model containing patient-related variables and acquisition parameters. Left ventricular ejection fraction (p < 0.001), type of collimation (p < 0.001), acquisition duration (p = 0.001), NYHA class (p = 0.028) and age (p = 0.034) were independent predictors of late H/M. Conclusions Acquisitions parameters are independent contributors to the variation of semi-quantitative measurements of cardiac ¹²³I-MIBG uptake. Improved standardisation of cardiac ¹²³I-MIBG imaging parameters would contribute to increased clinical applicability for this procedure.     

Combined therapy with carvedilol and amiodarone is more effective in improving cardiac symptoms, function, and sympathetic nerve activity in patients with dilated cardiomyopathy: Comparison with carvedilol therapy alone

Background  Carvedilol therapy has been reported to be more effective than other beta-blockers in patients with chronic heart failure (CHF). Amiodarone is an anti-arrhythmic medicine that has also been reported to be effective in patients with CHF. But the usefulness of combined therapy with carvedilol and amiodarone has not been reported. Methods  We compared 15 patients (M/F=3/12, age=57±8 y) with dilated cardiomyopathy (DCM) receiving carvedilol and amiodarone with 15 patients (M/F=3/12, age=61±9 y) receiving carvedilol alone. Patients were studied before and after 1 year of treatment (1Y). NYHA class and exercise capacity based on the specific-activity-scale (SAS), were assessed. Cardiac sympathetic nerve activity was estimated using total defect score (TDS), H/M ratio and washout rate (WR) of 123I-MIBG imaging. Cardiac function was evaluated using 99mTc-MIBI QGS. Results  Combined, therapy improved several parameters much more than carvedilol alone (p<0.05) including delta-TDS (15.0±8.6 vs. 7.6±7.2) and delta- WR (15.9±11.0% vs. 7.3±10.0%) for 123I-MIBG imaging, delta-LVEF (26.1±11.4% vs. 15.5±13.8%), delta-endsystolic volume (100±63.8 ml vs. 58.9±47.3 ml), 1Y NYHA class (1.5±0.5 vs. 1.9±0.5), 1Y SAS (7.3±0.7 Mets vs. 6.2±1.0 Mets), and delta-SAS (3.4±0.8 Mets vs. 2.6±1.1 Mets). Conclusion  Combined therapy with carvedilol and amiodarone is more effective in improving cardiac symptoms, exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with DCM.     

Assessment of central chemosensitivity and cardiac sympathetic nerve activity using I-123 MIBG imaging in central sleep apnea syndrome in patients with dilated cardiomyopathy

OBJECTIVE: Iodine-123 MIBG imaging has been used to study cardiac sympathetic function in various cardiac diseases. Central sleep apnea syndrome (CSAS) occurs frequently in patients with chronic heart failure (CHF) and is reported to be associated with a poor prognosis. One of the mechanisms of its poor prognosis may be related to impaired cardiac sympathetic activity. However, the relationship between chemosensitivity to carbon dioxide, which is reported to correlate with the severity of CSAS, and cardiac sympathetic activity has not been investigated. Therefore, this study was undertaken to assess cardiac sympathetic function and chemosensitivity to carbon dioxide in CHF patients. METHODS: The oxygen desaturation index (ODI) was evaluated in 21 patients with dilated cardiomyopathy (male/female: 19/2, LVEF < 45%, 65 +/- 12 yr). Patients with an ODI > 5 times/h underwent polysomnography. Patients with an apnea hypopnea index > 15/h but without evidence of obstructive apnea were defined as having CSAS. Early (15 min) and delayed (4 hr) planar MIBG images were obtained from these patients. The mean counts in the whole heart and the mediastinum were obtained. The heart-to-mediastinum count ratio of the delayed image (H/M) and the corrected myocardial washout rate (WR) were also calculated. The central chemoreflex was assessed with the rebreathing method using a hypercapnic gas mixture (7% CO2 and 93% O2). RESULTS: Ten of the 21 patients had CSAS. The H/M ratio was similar in patients both with and without CSAS (1.57 +/- 0.18 vs. 1.59 +/- 0.14, p = 0.82). However, the WR was higher in patients with CSAS than in patients without CSAS (40 +/- 8% vs. 30 +/- 12%, p < 0.05). ODI significantly correlated with central chemosensitivity to carbon dioxide. Moreover, there was a highly significant correlation between WR and central chemosensitivity (r = 0.65, p < 0.05). However, there was no correlation between ODI and the WR (r = 0.36, p = 0.11). CONCLUSIONS: Cardiac sympathetic nerve activity in patients with CHF and CSAS is impaired. However, central sleep apnea might not directly increase cardiac sympathetic nerve activity. We suggest that central chemosensitivity, which is considered to be one of the mechanisms of CSAS, is correlated with cardiac sympathetic nerve activity.     

Prognostic value of <Superscript>123</Superscript>I-metaiodobenzylguanidine in patients with various heart diseases

Objective It has been reported that ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy can predict the poor prognosis in patients with dilated cardiomyopathy (DCM). However, the prognostic significance of MIBG is still unknown in patients with other heart diseases. In this study, we compared the prognosis and MIBG findings in various heart diseases. Methods Consecutive 565 patients undergoing MIBG scintigraphy were enrolled (392 men, 52 ± 16 years). Indications were that 127 had ischemic heart disease (IHD), 120 DCM, 101 hypertrophic cardiomyopathy (HCM), 21 hypertensive heart disease (HHD), 58 volume-load valvular disease (VVD), 38 pressure-load valvular disease (PVD), and 101 ventricular tachycardia or fibrillation (VTF). Heart-to-mediastinum ratio (H/M) and washout rate (WR) of MIBG were evaluated. Cardiac events were defined as sudden cardiac death, heart failure, and acute ischemic event (follow-up, 22.7 ± 17.0 months). Results A total of 106 cardiac events including 40 cardiac deaths occurred. Cox hazard model analysis showed that in the IHD, HCM, and DCM groups, H/M and WR were associated with cardiac death, but not in the HHD, PVD, VVD, or VTF groups. Only death and congestive heart failure (CHF) episodes were related to H/M and WR. On the other hand, fatal arrhythmia, myocardial infarction, or angina pectoris were not related to H/M and WR. The data indicated that WR or H/M may predict death and CHF but does not predict fatal arrhythmia or acute ischemic event. Conclusions MIBG WR and H/M were associated with heart failure, sudden death, and cardiac death events, and were useful to predict the prognosis in DCM, HCM, and IHD. In contrast, fatal arrhythmia events were not associated with MIBG indices, and thus it does not appear to be useful in predicting cardiac events in patients with VTF.     

Left ventricular function and visual phase analysis with equilibrium radionuclide angiography in patients with biventricular device

Purpose Cardiac resynchronisation therapy (CRT) is a technique indicated in patients with moderate to severe heart failure and ventricular dyssynchrony. To evaluate left ventricular ejection fraction (LVEF) and synchronisation changes after CRT with a biventricular pacing implant, we used an equilibrium radionuclide angiography (ERNA). Methods Fifty patients were studied. An ERNA was made 72 h and 6 months after the implant. Two acquisitions were performed: with the CRT device connected and after disconnecting it. In the follow-up, responders were defined as those who had improved in accordance with various clinical variables. Quantitative changes in LVEF and visual changes in synchronisation (phase analysis) were studied comparing the two studies and also comparing the connected and disconnected modes. Results At 6 months, 30 patients were defined as responders. LVEF increased significantly at 6 months compared with the 72-h study only in responders. At 72 h, the number of patients showing a decrease in LVEF (p < 0.05) or a synchronisation worsening after disconnecting the device was higher in responders than in nonresponders. At 6 months, 57% of responders had no synchronisation changes between the connected and disconnected modes, suggesting a resynchronisation process. Conclusions ERNA permits the study of resynchronisation patients, showing a statistical LVEF improvement at 6 months. Moreover, visual phase analysis permits the study of the mechanism involved in the response, with an important number of responders with no changes between the two modes at 6 months. In the 72-h study, after disconnection of the device, LVEF and resynchronisation worsening can predict patient improvement at 6 months.     

Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy.

Alterations of cardiac sympathetic innervation are likely to contribute to fatal outcomes in patients with heart failure. These alterations can be evaluated noninvasively by 123I-metaiodoben-zylguanidine (MIBG) imaging. METHODS: The hypothesis that impaired cardiac sympathetic innervation, as assessed using MIBG imaging, is related to adverse outcomes was tested in 112 patients with heart failure resulting from idiopathic cardiomyopathy. Main inclusion criteria were New York Heart Association classes II-IV and radionuclide left ventricular ejection fraction (LVEF) < 40%. Patients were assessed for cardiac MIBG uptake, circulating norepinephrine concentration, LVEF, peak Vo2, x-ray cardiothoracic ratio, M-mode echographic end-diastolic diameter and right-sided heart catheterization parameters. RESULTS: During a mean follow-up of 27 +/- 20 mo, 19 patients had transplants, 25 died of cardiac death (8 sudden deaths), 2 died of noncardiac death and 66 survived without transplantation. The only independent predictors for mortality were low MIBG uptake (P < 0.001) and LVEF (P = 0.02) when using multivariate discriminant analysis. Moreover, MIBG uptake (P < 0.001) and circulating norepinephrine concentration (P = 0.001) were the only independent predictors for life duration when using multivariate life table analysis. CONCLUSION: Impaired cardiac adrenergic innervation as assessed by MIBG imaging is strongly related to mortality. MIBG imaging may help risk stratify patients with heart failure resulting from idiopathic dilated cardiomyopathy.     

CMR对扩张性心肌病的应用价值

扩张性心肌病（DCM）的早期诊断及病情监测对其预后非常重要。心脏磁共振（CMR）可以无创性评估心肌的形态、功能及组织特性,有利于DCM的诊断和管理。就延迟钆增强、T₁ mapping、T₂ mapping及CMR特征追踪等CMR技术在DCM的早期诊断、病情监测与评估、预后预测以及鉴别诊断方面的应用价值进行综述。     

Monitoring chemotherapy-induced cardiotoxicity: Role of cardiac nuclear imaging

Cardiotoxicity may result from a range of chemotherapeutic agents. The prevalence of cardiotoxicity from certain cytotoxic agents is reported to be significantly high. In addition to serious side effects and increased long-lasting morbidity and mortality, dose limitation and suboptimal usage is an important adverse effect. Nuclear cardiac imaging has played a quintessential and important role in identifying patients at risk and in the prevention and reduction of cardiac injury resulting from cytotoxic agents. Despite exploring a number of other diagnostic imaging or biochemical tools for identification of cardiac injury, nuclear cardiac imaging in the form of radionuclide angiocardiography continues to be the most suitable and cost-effective tool for reducing the prevalence of cases of cardiac dysfunction resulting from chemotherapy. This article reviews the prevalence, mechanisms, and prevention strategies for cardiotoxicity associated with some of the commonly known cytotoxic agents and the role of nuclear cardiac imaging in its monitoring and prevention, along with recent advances in this area.     

芪苈强心胶囊对扩张型心肌病心力衰竭患者心功能及血浆脑利钠肽水平的影响

目的观察芪苈强心胶囊对扩张型心肌病（DCM）心力衰竭患者心功能及血浆脑利钠肽水平的影响。方法 62例DCM心力衰竭患者随机分为研究组30例和对照组32例,2组患者均给予常规抗心力衰竭的治疗,如限盐、休息,选用利尿剂、血管紧张素转化酶抑制剂、β受体阻滞剂、螺内酯、硝酸酯类药物等,根据病情必要时应用洋地黄、多巴酚丁胺等正性肌力药物。研究组在常规治疗基础上加服芪苈强心胶囊（4粒,每日3次）。疗程均为1个月。观察2组治疗前后心功能改善情况：左室舒张末内径（LVEDD）、左室射血分数（LVEF）、6min步行距离和血浆脑利钠肽（BNP）水平,以及药物副作用。结果治疗1个月后,研究组与治疗前及对照组相比,LVEDD缩小,BNP下降;而LVEF和6min步行距离增加;差异有统计学意义（P〈0.01及P〈0.05）。2组均未发现明显不良反应。结论芪苈强心胶囊治疗DCM心力衰竭疗效较好,可提高LVEF,改善运动耐量,降低血浆BNP水平,是较为安全有效的方法 。     

Myocardial oxidative metabolic supply-demand relationships in patients with nonischemic dilated cardiomyopathy

Background  Nonischemic dilated cardiomyopathy (NIDCM) is associated with left ventricular remodeling, hypertrophy, and mitochondrial metabolic abnormalities in vitro. We evaluated the hypothesis that energy supply, as judged by the rate of myocardial oxidative metabolism, is inadequate to meet oxygen demand in patients with NIDCM compared with normal subjects. Methods and Results  We used positron emission tomography to determine the myocardial carbon 11 acetate decay rate (k_mono) as an index of energy supply, and we compared k_mono with the rate-pressure product (RPP) as an index of metabolic demand in 7 patients with NIDCM and 7 normal subjects. The mean k_mono value (SEM) was 0.060 ± 0.006 min_-1 in NIDCM patients versus 0.054 ± 0.002 in normal subjects (P = not significant). The RPP was 9949 ± 931 beats/min · mm Hg in NIDCM patients and 6521 ± 476 in normal subjects (P = .007). The relationship of k_mono to this index of demand (k_mono/RPP) was 6.2 x 10_-6 in NIDCM patients but was 8.5 x 10_-6 in normal subjects (P = .003). Thus RPP, as an index of myocardial oxygen demand, was poorly matched by the rate of oxidative metabolism in those patients with NIDCM. The k_mono was closely related to RPP in normal subjects (r = 0.83, P = .02) but not in NIDCM patients. Furthermore, there was no significant relationship between k_mono and wall stress as another index of oxygen demand. Conclusions  These results are consistent with a mitochondrial metabolic abnormality in heart failure. This metabolic mismatch detected by positron emission tomography may contribute to the pathophysiology of congestive heart failure and left ventricular remodeling. Supported in part by a grant from Sanofi-Synthelabo, New York, NY.     

Prognostic value of left-ventricular and peripheral vascular performance in patients with dilated cardiomyopathy

Background. The goal of the heart during exercise is to increase cardiac output to metabolizing tissues. Our aim was to assess the relative role of systolic versus diastolic dysfunction in modulating cardiac output in patients with idiopathic left-ventricular (LV) dysfunction. Methods. We enrolled 51 patients (LV ejection fraction, mean ±SD, =36% ±9%) and 24 controls with a normal LV ejection fraction. All were scheduled for exercise radionuclide angiography for the evaluation of LV functional reserve, and were followed for a median of 129 months. Results. Stroke volume increased in control subjects mainly through a decrease in end-systolic volume, while it increased in patients through an increase in end-diastolic volume (EDV), albeit heterogeneously. Patients were divided into group I, with stroke volume increase, versus group II, without stroke volume increase, during stress. Despite similar blunted inotropic reserves, group I showed a decrease in arterial elastance during stress: a better ventricular-arterial coupling occurred, leading to increased cardiac efficiency. At long-term follow-up, the overall event-free survival was 88% in group I, compared with 61% for group II (log rank =4.7, P=03). Conclusions. In the presence of idiopathic LV dysfunction, a preserved LV pumping reserve can be identified easily through stress-induced variations in the EDV and stroke volume, with a powerful, long-term death-risk stratification.     

富马酸比索洛尔对扩张型心肌病致心衰的疗效观察

目的：观察富马酸比索洛尔对扩张型心肌病致心衰的疗效。方法：68例病人常规治疗2周后加服小剂量富马酸比索洛尔4周,比较治疗前后心功能参数,24h室性心律失常数总数及临床效果。结果：治疗后心率明显低于治疗前（P＜0．05）,心脏彩超心功能参数显著改善（P＜0．05）,治疗后24h室性心律失常数总数显著下降（P＜0．01）,临床总有效率92．65％,结论：小剂量富马酸比索洛尔能改善扩张型心肌病病人心功能,减少室性心律失常发生,改善心衰症状,小剂量慎用值得临床选择。     

核素显像鉴别缺血性和扩张性心肌病的综合评价

介绍了核素心肌灌注、心肌代谢、核素心室显像在缺血性心肌病(CAD-CM)和扩张性心肌病(DCM)鉴别诊断中的意义。扩张性心肌病患者心肌灌注显像多表现为放射性分布不均匀,无灌注缺损,代谢显像常与灌注显像一致,核素心室显像表现为弥漫性的室壁运动异常。缺血笥心肌病患者心肌灌注显像多表现严重的灌注异常,有灌注缺损且呈节段性分布,灌注与代谢显像不匹配多见,核素心室显像表现为节段性的定壁运动减低。     

Impact of mediastinal,liver and lung <Superscript>123</Superscript>I-metaiodobenzylguanidine (<Superscript>123</Superscript>I-MIBG) washout on calculated <Superscript>123</Superscript>I-MIBG myocardial washout

Purpose  In planar ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) myocardial imaging mediastinum (M) activity is often used as a background correction in calculating “washout” (WO). However, the most likely sources for counts that might produce errors in estimating myocardial (Myo) activity are lung (Lu) and liver (Li), which typically have higher counts/pixel (cpp) than M. The present study investigated the relationship between changes in Lu, Li and Myo activity between early and late planar ¹²³I-MIBG images, with comparison to M as the best estimator of non-specific background activity. Methods  Studies on 98 subjects with both early (e) and late (l) planar ¹²³I-MIBG images were analysed. There were 68 subjects with chronic heart failure (CHF), 14 with hypertension (HTN) but no known heart disease and 16 controls (C). For each image, regions of interest (ROIs) were drawn: an irregular whole Myo, Lu, upper M and Li. For each ROI, WO was calculated as [(cpp(e)-cpp(l:decay corrected))/cpp(e)]×100%. Results   Multivariable forward stepwise regression analysis showed that overall a significant proportion of the variation in Myo WO could be explained by a model containing M WO and Lu WO (37%, p < 0.001). Only in controls was M WO the sole variable explaining a significant proportion of the variation in Myo WO (27%, p = 0.023). Conclusion  Although increased Myo WO in CHF subjects reflects disease severity, part of the count differences measured on planar ¹²³I-MIBG myocardial images likely reflects changes in the adjacent and surrounding Lu tissue. The results for the controls suggest that this is the only group where a mediastinum correction alone may be appropriate for cardiac WO calculations.     

Abnormal sympathetic innervation of the heart in a patient with Emery-Dreifuss muscular dystrophy

A 33-year-old man was admitted for general malaise and vomiting. An electrocardiogram showed a complete atrioventricular block and an echocardiogram showed right atrial dilatation and normal wall motion of left ventricle (LV). Gene analysis showed nonsense mutation in the STA gene, which codes for emerin, and Emery-Dreifuss muscular dystrophy was diagnosed. An endomyocardial biopsy of right ventricle showed mild hypertrophy of myocytes. Myocardial scintigraphic studies with Tc-99m methoxyisobutylisonitrile (MIBI) and I-123-betamethyl-p-iodophenylpentadecanoic acid (BMIPP) scintigrams showed no abnormalities. In contrast, I-123 metaiodobenzylguanidine (MIBG) scintigrams showed a diffuse and severe decrease in accumulation of MIBG in the heart. Six months later, his LV wall motion on echocardiograms developed diffuse hypokinesis. These results suggest that the abnormality on I-123 MIBG myocardial scintigrams may predict LV dysfunction in Emery-Dreifuss muscular dystrophy.     

Accuracy of 16-detector multislice spiral computed tomography in the initial evaluation of dilated cardiomyopathy

BACKGROUND: Multislice Computed Tomography (MSCT) recently proved its accuracy in the detection of coronary artery disease (CAD). It can also give information about left ventricular function and venous network anatomy. We here sought to validate a MSCT-based strategy in the initial evaluation of patients with dilated cardiomyopathy (DCM). METHODS: 36 patients with DCM underwent cardiac MSCT before conventional coronary angiography with ventriculography. We analysed arterial calcium score (Agatston score equivalent: ASE), coronary stenosis, left ventricular parameters and venous network. RESULTS: The sensitivity of a MSCT-based strategy in detecting significant CAD was 100% and the specificity 80%. The positive and negative predictive values were respectively 67% and 100%. For ASE <1.000 (75% of patients), MSCT detected all non-CAD patients without one (motion artifacts), enabling conventional angiography to be avoided in 21/27 patients (77.7%). For ASE > or =1000, MSCT enabled conventional angiography to be avoided in only 2/9 patients (22.2%). The ventricle was assessable in 83.4% (30 patients) on MSCT. Correlation coefficient Rs with ventriculography were 0.78 (p<0.0001), 0.77 (p<0.0001) and 0.82 (p<0.0001) respectively for end-diastolic volume, end-systolic volume and EF. The venous network was assessable in all patients both on MSCT and angiography. CONCLUSION: In patients undergoing an initial evaluation of DCM, MSCT appears to be an effective alternative to conventional angiography. The following attitude may be proposed: when ASE >1.000, conventional coronary angiography is mandatory due to MSCT's poor interest in such cases; when ASE <1.000, a contrast-enhanced MSCT may, when normal, replace coronary angiography.     

高剂量曲美他嗪对扩张型心肌病心衰患者预后影响

目的分析高剂量曲美他嗪(120 mg/d)对扩张型心肌病(DCM)心衰患者预后的影响。方法选取西京医院心内科及沈阳军区总医院心内科2014年出院的DCM心衰患者150例,随访1~2年,失访14例,最终纳入136例患者。按曲美他嗪使用剂量将患者分为高剂量组(40 mg,每天3次,n=13)、常规剂量组(20 mg,每天3次,n=99)及对照组(未服用,n=24),比较3组患者用药前后心功能、影像学改变及代谢相关指标的差异。结果高剂量组患者年龄、射血分数(EF)值均偏低(P<0.05);左心室收缩内径(LVESD)、CO、缩短分数(FS)、每搏输出量(SV)值均偏高(P<0.05);主要合并用药包括血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂(100%)、利尿剂(76.92%)及洋地黄(76.92%)。服用药物1~2年后,高剂量组患者脑钠肽、FS值、EF值均较常规剂量组明显减小,LVESD值较常规剂量组明显增大。高剂量与常规剂量的曲美他嗪均可降低CO值,且SV值改变均较对照组大。结论高剂量曲美他嗪常被用于病情偏重患者,但其疗效一般,仍需进一步证实。     

Comparison of radionuclide ventriculography using SPECT and planar techniques in different cardiac conditions

PURPOSE: Accurate assessment of ventricular function is required to optimize therapeutic management of cardiac diseases. The aim of this study was to correlate planar equilibrium multigated acquisition (MUGA) with tomographic ventriculography (SPECT) in patients with diverse volumes and wall motion abnormalities. METHODS: Eighty-three studies in 80 patients (56+/-14 years; 56% women) were classified according to ventricular dilation, wall motion abnormalities and systolic dysfunction. Left and right ventricular ejection fraction (LVEF and RVEF) and end-diastolic and end-systolic left ventricular volumes (EDV and ESV) were obtained using a commercial QBS program for SPECT. On planar acquisition, LVEF and RVEF were obtained using standard techniques and volumes were determined using the count-based method, without blood sampling. RESULTS: A. Total group: With the planar method, LVEF was 44+/-17%, RVEF 42+/-13%, left EDV 147+/-97 ml (range 31-487 ml) and left ESV 93+/-85 ml (range 15-423 ml); with SPECT the corresponding values were 40+/-20%, 49+/-16%,131+/-95 ml and 91+/-89 ml, respectively (p=NS for all but RVEF). Linear correlation was 0.845 for LVEF, 0.688 for RVEF, 0.927 for left EDV and 0.94 for left ESV, with good intra-class correlation. B. Subgroups: Global and intra-class correlations between planar imaging and SPECT were high for volumes, RVEF and LVEF in all subgroups, except in patients with normal wall motion and function, who showed smaller volumes with SPECT. The group with diffuse wall motion abnormalities had a lower EDV on SPECT. In the abnormal left ventricle, RVEF was higher with SPECT. CONCLUSION: Good correlation and agreement exist between SPECT and planar MUGA with respect to LVEF and left ventricular volumes. SPECT is useful in patients with functional abnormalities, but less reliable in those with normal small cavities. A combined technique is still necessary, and RVEF should be interpreted cautiously.