Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning
Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (L...
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| Veröffentlicht in: | Nuclear medicine communications 2001-06, Vol.22 (6), p.685-693 |
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| description | Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of Tc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P = 0.008 and P |
| doi_str_mv | 10.1097/00006231-200106000-00013 |
| format | Article |
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Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of Tc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (<5%) of coronary artery disease (CAD). In 50 of the 147 (34%) of patients with reversible perfusion defects, post-stress LVEF was >5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P = 0.008 and P<0.000001, respectively) and with the subgroup 2A (P = 0.011 and P<10, respectively). The ESV stress/rest ratio correlated significantly with the summed WT difference score by univariate analysis in stunned patients. It can be concluded that the post-stress ESV dilation, obtained by stress/rest gated SPECT, seems to be due to endocardial post-ischemic stunning. The stunned patients showed more severe clinical, angiographic, perfusion and function parameters.</description><identifier>ISSN: 0143-3636</identifier><identifier>EISSN: 1473-5628</identifier><identifier>DOI: 10.1097/00006231-200106000-00013</identifier><identifier>PMID: 11403181</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular system ; Chest Pain - diagnostic imaging ; Coronary Angiography ; Coronary Circulation - physiology ; Coronary Disease - diagnostic imaging ; Coronary heart disease ; Exercise Test - methods ; Female ; Gated Blood-Pool Imaging ; Heart ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Myocardial Stunning - physiopathology ; Organophosphorus Compounds ; Organotechnetium Compounds ; Radionuclide investigations ; Radiopharmaceuticals ; Stroke Volume ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Vasodilation - physiology ; Ventricular Function, Left - physiology</subject><ispartof>Nuclear medicine communications, 2001-06, Vol.22 (6), p.685-693</ispartof><rights>2001 Lippincott Williams & Wilkins, Inc.</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3853-fcdb58000c9094dd03d1113ba069d5539e16ba49e91d07a36dcd2df156ed92273</citedby><cites>FETCH-LOGICAL-c3853-fcdb58000c9094dd03d1113ba069d5539e16ba49e91d07a36dcd2df156ed92273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1022304$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11403181$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BESTETTI, A</creatorcontrib><creatorcontrib>DI LEO, C</creatorcontrib><creatorcontrib>ALESSI, A</creatorcontrib><creatorcontrib>TRIULZI, A</creatorcontrib><creatorcontrib>TAGLIABUE, L</creatorcontrib><creatorcontrib>TAROLO, G L</creatorcontrib><title>Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning</title><title>Nuclear medicine communications</title><addtitle>Nucl Med Commun</addtitle><description>Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of Tc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (<5%) of coronary artery disease (CAD). In 50 of the 147 (34%) of patients with reversible perfusion defects, post-stress LVEF was >5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P = 0.008 and P<0.000001, respectively) and with the subgroup 2A (P = 0.011 and P<10, respectively). The ESV stress/rest ratio correlated significantly with the summed WT difference score by univariate analysis in stunned patients. It can be concluded that the post-stress ESV dilation, obtained by stress/rest gated SPECT, seems to be due to endocardial post-ischemic stunning. The stunned patients showed more severe clinical, angiographic, perfusion and function parameters.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Chest Pain - diagnostic imaging</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary heart disease</subject><subject>Exercise Test - methods</subject><subject>Female</subject><subject>Gated Blood-Pool Imaging</subject><subject>Heart</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Stunning - physiopathology</subject><subject>Organophosphorus Compounds</subject><subject>Organotechnetium Compounds</subject><subject>Radionuclide investigations</subject><subject>Radiopharmaceuticals</subject><subject>Stroke Volume</subject><subject>Thallium</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Vasodilation - physiology</subject><subject>Ventricular Function, Left - physiology</subject><issn>0143-3636</issn><issn>1473-5628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUuPFCEUhYlx4rSjf8GwMO5QLlRRhTsz8ZVMMrMY14QCysahi5ZLOZl_L223j40khJB859zDgRAK_DVwPbzhbSkhgQnOgat2Y22DfEQ20A2S9UqMj8mGQyeZVFKdk6eI3xoySjU8IecAHZcwwoZMNxkrw1oCIg2LZ_iANafoaApzpT_CUkt0a7KF-phsjXl5Sy3d2XIXCs3zQZOdLT7aRPcHr4huG3bNAOu6LHH5-oyczTZheH46L8iXD-9vLz-xq-uPny_fXTEnx16y2fmpH1tGp7nuvOfSA4CcLFfa973UAdRkOx00eD5Yqbzzws_Qq-C1EIO8IK-OvvuSv68Bq9m1LCElu4S8ohm4FnqUXQPHI-hKRixhNvsS24seDHBz6Nf87tf86df86rdJX5xmrNMu-L_CU6ENeHkCLDqb5mIXF_GfAUJIfojQHbH7nGooeJfW-1DMNthUt-Z_3yt_AiR8kq4</recordid><startdate>200106</startdate><enddate>200106</enddate><creator>BESTETTI, A</creator><creator>DI LEO, C</creator><creator>ALESSI, A</creator><creator>TRIULZI, A</creator><creator>TAGLIABUE, L</creator><creator>TAROLO, G L</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200106</creationdate><title>Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning</title><author>BESTETTI, A ; DI LEO, C ; ALESSI, A ; TRIULZI, A ; TAGLIABUE, L ; TAROLO, G L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3853-fcdb58000c9094dd03d1113ba069d5539e16ba49e91d07a36dcd2df156ed92273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Chest Pain - diagnostic imaging</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary heart disease</topic><topic>Exercise Test - methods</topic><topic>Female</topic><topic>Gated Blood-Pool Imaging</topic><topic>Heart</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Stunning - physiopathology</topic><topic>Organophosphorus Compounds</topic><topic>Organotechnetium Compounds</topic><topic>Radionuclide investigations</topic><topic>Radiopharmaceuticals</topic><topic>Stroke Volume</topic><topic>Thallium</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Vasodilation - physiology</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BESTETTI, A</creatorcontrib><creatorcontrib>DI LEO, C</creatorcontrib><creatorcontrib>ALESSI, A</creatorcontrib><creatorcontrib>TRIULZI, A</creatorcontrib><creatorcontrib>TAGLIABUE, L</creatorcontrib><creatorcontrib>TAROLO, G L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nuclear medicine communications</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BESTETTI, A</au><au>DI LEO, C</au><au>ALESSI, A</au><au>TRIULZI, A</au><au>TAGLIABUE, L</au><au>TAROLO, G L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning</atitle><jtitle>Nuclear medicine communications</jtitle><addtitle>Nucl Med Commun</addtitle><date>2001-06</date><risdate>2001</risdate><volume>22</volume><issue>6</issue><spage>685</spage><epage>693</epage><pages>685-693</pages><issn>0143-3636</issn><eissn>1473-5628</eissn><abstract>Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of Tc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (<5%) of coronary artery disease (CAD). In 50 of the 147 (34%) of patients with reversible perfusion defects, post-stress LVEF was >5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P = 0.008 and P<0.000001, respectively) and with the subgroup 2A (P = 0.011 and P<10, respectively). The ESV stress/rest ratio correlated significantly with the summed WT difference score by univariate analysis in stunned patients. It can be concluded that the post-stress ESV dilation, obtained by stress/rest gated SPECT, seems to be due to endocardial post-ischemic stunning. The stunned patients showed more severe clinical, angiographic, perfusion and function parameters.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11403181</pmid><doi>10.1097/00006231-200106000-00013</doi><tpages>9</tpages></addata></record> |
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| ispartof | Nuclear medicine communications, 2001-06, Vol.22 (6), p.685-693 |
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| language | eng |
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| subjects | Aged Biological and medical sciences Cardiology. Vascular system Cardiovascular system Chest Pain - diagnostic imaging Coronary Angiography Coronary Circulation - physiology Coronary Disease - diagnostic imaging Coronary heart disease Exercise Test - methods Female Gated Blood-Pool Imaging Heart Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Myocardial Stunning - physiopathology Organophosphorus Compounds Organotechnetium Compounds Radionuclide investigations Radiopharmaceuticals Stroke Volume Thallium Tomography, Emission-Computed, Single-Photon Vasodilation - physiology Ventricular Function, Left - physiology |
| title | Post-stress end-systolic left ventricular dilation: a marker of endocardial post-ischemic stunning |
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