Non-invasive detection of ischemic left ventricular dysfunction using rest gated SPECT: expectation of simultaneous evaluation of both myocardial perfusion and wall motion abnormality |
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Authors: | Hirofumi Maeba Kazuya Takehana Seishi Nakamura Susumu Yoshida Takanao Ueyama Kengo Hatada Toshiji Iwasaka |
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Institution: | Division of Cardiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, Japan. maebah@hirakata.kmu.ac.jp |
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Abstract: | OBJECTIVE: Although the accurate detection of ischemic etiology is important in the management of patients with severe left ventricular (LV) dysfunction, it is difficult to determine using a non-invasive strategy. The present study investigates whether perfusion and regional functional abnormalities identified by quantitative electrocardiographic gated single-photon emission computed tomography (QGS) at rest can detect ischemic LV dysfunction in patients with severe LV dysfunction. METHODS: Rest QGS with (99m)Tc-tetrofosmin was performed on 54 consecutive patients with LV ejection fraction of =40%. Ischemic LV dysfunction (n = 32) was defined according to the established standard. Regional perfusion and wall motion were calculated using a 14-segment model (six mid-ventricular and eight apical segments) and compared with a normal control group. RESULTS: The numbers of reduced mean -1 standard deviation (SD) of normal individuals] and severely reduced (mean -2 SD) wall motion segments were similar between patients with ischemic and non-ischemic LV dysfunction (13.5 +/- 1.1 vs. 13.6 +/- 0.9 and 10.6 +/- 2.0 vs. 9.9 +/- 3.0 segments, respectively). The number of hypoperfused (mean -1 SD) segments was significantly greater in patients with ischemic LV dysfunction than in those with non-ischemic LV dysfunction (9.3 +/- 3.8 vs. 2.0 +/- 2.8 segments, P < 0.0001). The analysis of the receiver operating characteristics showed that a cut-off value of 4 hypoperfused segments among 14 segments provided the best separation between ischemic and non-ischemic LV dysfunction (sensitivity = 88% and specificity = 91%). Furthermore, patients with non-ischemic LV dysfunction had no severely hypoperfused (mean -2 SD) segments in any of the segments, whereas patients with ischemic LV dysfunction had 4.4 +/- 0.2 segments. CONCLUSIONS: The QGS strategy at rest can accurately differentiate patients with ischemic LV dysfunction from those with severe LV dysfunction by simultaneous regional evaluation of wall motion and myocardial perfusion. |
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Keywords: | Left ventricular dysfunction Ischemic LV dysfunction Electrocardiographic gated SPECT |
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