12.6 Demonstration of myocardial stunning after dipyridamole stress test with gated perfusion SPECT

SummaryCardiac syndrome X defines patients with typical anginal chest pain, a positive exercise ECG stress test and angiographically normal coronary arteries. Aim of this study was to evaluate the role of myocardial perfusion SPECT with dipyridamole stress in the diagnosis of cardiac syndrome X. Patients, methods: 68 patients with syndrome X aged 32 to 60 years were subjected to myocardial imaging using 99mTc-MIBI according to the two-days protocol: at rest and after dipyridamole infusion. Semiquantitative evaluation of the images was based on the assessment of 99mTc-MIBI uptake in 17 myocardial segments using a 5-points scale (0 point – normal uptake, 4 points – no uptake). Scores obtained in each segment were summed up, constituting the summed rest score (SRS) and summed stress score (SSS). Results: Mean SRS was 7.9 ± 4.8 and mean SSS was 7.2 ± 4.4 (non-significant difference). Individual comparison of SRS and SSS values revealed three patterns of scintigraphic images: 1) in 25 patients (36.8%), a paradoxical improvement of perfusion at stress images was found, 2) in 23 patients (33.8%), the myocardial perfusion deteriorated after dipyridamole, 3) in 20 patients (29.4%), no significant change of the myocardial perfusion between rest and stress images occurred. Conclusions: In cardiac syndrome X, myocardial SPECT with dipyridamole stress shows different patterns of myocardial perfusion that reflects heterogeneity of this pathology.

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ROC Analysis of Three Perfusion Display Options for ECG-gated Perfusion SPECT in Severe CAD

Nuklearmedizin ◽

10.1055/s-0038-1632214 ◽

1999 ◽

Vol 38 (06) ◽

pp. 172-177

Author(s):

H. Bailer ◽

Marianne Gwechenberger ◽

Martha Pruckmayer ◽

A. Staudenherz ◽

G. Kronik ◽

...

Keyword(s):

Roc Analysis ◽

Lateral Wall ◽

Visual Assessment ◽

3D Mapping ◽

Operating Characteristics ◽

Gated Perfusion Spect ◽

Perfusion Spect ◽

Coronary Stenoses ◽

Definition Of ◽

Valve Plane

Summary Aim: The simultaneous computation and display of wall motion and perfusion patterns in a single 3D ventricular model would considerably ease the assessment of ECG-gated Tc-99m-sestamibi SPECT, yet the effect on the accuracy of allocating regional perfusion has so far not been validated. Methods: 3D perfusion mapping (3D Perfusion/Motion Map Software) was compared to the visual assessment of ungated tomographic slices and polar perfusion mapping (Cedars-Sinai PTQ) by correlation analysis and receiver operating characteristics (ROC) analysis at different cut-off levels for coronary stenoses in 50 patients (11 single-, 22 two-, 16 three-vessel disease). Ungated SPECT data were obtained by adding the intervals prior to reconstruction and displaying conventional tomographic slices. All display options were visually assessed in 8 ventricular segments according to a 4-point scoring system and compared to the graded results of coronary angiography. Results: All three display options showed a comparable diagnostic performance for the detection of severe stenoses. The diagnostic gain for the detection of stenoses above 59% was highest for ungated tomographic slices, followed by ungated polar mapping and 3D mapping. Regional assessment revealed a limited performance of 3D mapping in the proximal anterior and distal lateral wall. Polar mapping showed a balanced regional performance. Conclusion: 3D Perfusion mapping provides comparable information to conventional display options with the highest diagnostic strength in severe stenoses. Further improvement of the algorithm is needed in the definition of the valve plane.

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Inverse response of global longitudinal strain after dipyridamole stress echocardiography in patients with microvascular coronary dysfunction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0022 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Tagliamonte ◽

C Montuori ◽

L Riegler ◽

A Forni ◽

R Scarafile ◽

...

Keyword(s):

Coronary Flow ◽

Stress Echocardiography ◽

Stress Test ◽

Global Longitudinal Strain ◽

Inverse Correlation ◽

Left Ventricular ◽

Peak Dose ◽

Different Response ◽

Dipyridamole Stress Echocardiography ◽

Dipyridamole Stress

Abstract Background Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD. The aim of this study was to investigate the dipyridamole-induced changes of global longitudinal strain (GLS) in patients with CMD. Methods 43 patients (29M, 14F; mean age 68±7 years) without obstructive CAD, assessed by invasive coronary angiogram, underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery (LAD) and was identified as the colour signal directed from the base to the apex of the left ventricle, containing the characteristic biphasic pulsed-Doppler flow signals. CFR were determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR <2. GLS was measured using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull's-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population. In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline. Results Thirteen patients (30%) among the overall population showed CMD. There were no significant differences in baseline characteristics between patients with or without CMD. GLS, at baseline, was significantly lower in patients with CMD (−16.9±3.78 vs. −17.8±3.77 – p<0.01). We observed a different response to dipyridamole stress echocardiography, between the two groups: GLS significantly increased up to peak dose in patients without CMD (from −17.8±3.77 to −19.3±4.09 – p<0.01), whereas on the other hand, a significant decrease from rest to peak dose was observed in patients with CMD (from −16.9±3.78 to −15.5±4.18 – p<0.01). There was a significant inverse correlation between CFR and delta GLS measured at rest and after dipyridamole peak dose (r=−0.82 – p<0.01). Conclusions GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of left ventricular myocardiim to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of left ventricular myocardial function in these patients. Larger studies could confirm our data. Funding Acknowledgement Type of funding source: None

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Сравнительный анализ данных перфузионной сцинтиграфии миокарда у пациентов с поражением коронарных артерий различной степени выраженности

Kardiologicheskii vestnik ◽

10.36396/ms.2019.15.4.008 ◽

2019 ◽

Cited By ~ 1

Author(s):

E DENISENKO-KANKIYA ◽

F.N. CHANAKHCHIAN ◽

E.I. VASILENKO ◽

M.N. VAKHROMEEVA

Keyword(s):

Myocardial Perfusion ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Vulnerable Atherosclerotic Plaque ◽

Gated Perfusion Spect ◽

Perfusion Spect ◽

Perfusion Defects ◽

Reversible Ischemia ◽

Myocardial Perfusion Defects

Известно, что дестабилизация атеросклеротической бляшки коронарных артерий (КА) играет ключевую роль в развитии осложнений хронической ишемической болезни сердца (ИБС). Ранняя диагностика ишемии миокарда и определение субклинического стеноза КА с помощью неинвазивного метода визуализации сердца может стать важным методом в предотвращении развития сердечно-сосудистых осложнений у данной популяции больных. Цель исследования. Определить выраженность преходящих нарушений перфузии миокарда, выявленных при однофотонной эмиссионной компьютерной томографии (ОЭКТ) миокарда у пациентов со стенозами КА различной степени тяжести. Материал и методы. В исследование включен 231 пациент (средний возраст 6210лет). Проанализированы факторы кардиального риска. Всем пациентам проводили ОЭКТ миокарда по стандартному протоколу. Региональную перфузию миокарда оценивали с использованием стандартизированной 20-сегментной модели, на которой оценивали: SSS общий счет снижения перфузии миокарда при нагрузке SDS общую разницу счета, соответствующую степени выраженности преходящей ишемии левого желудочка (ЛЖ). На основании полученных данных обследуемых пациентов классифицировали на группы: с нормальной перфузией (SSS4), незначительной (SSS4-6), умеренной и выраженной степенью снижения (SSS712 и SSS13 соответственно) перфузии миокарда ЛЖ. Результаты SDS классифицировали как: отсутствие ишемии (SDS2), умеренная преходящая ишемия (SDS2-6) и выраженная преходящая ишемия (SDS7). Количественные показатели перфузии миокарда сравнивали с результатами инвазивной коронароангиографии (КАГ). Результаты. Из 231 пациента у 69 (29,9) по данным КАГ были выявлены стенозы до 20, у 126 (54,5) стенозы 2049, у 36 (15,6) стенозы 50 и более. Сравнительный анализ количественных показателей перфузии миокарда (SSS и SDS) и результатов КАГ показал, что достоверные дефекты перфузии после нагрузки и преходящая ишемия ЛЖ определены в основном у пациентов со стенозами КА50 (47,2 и 63,9 соответственно, р0,01). В группе пациентов с стенозами КА 2049 у 42,1 показатели SSS соответствовали незначительной (25,4) и умеренной (16,7) степени снижения перфузии после нагрузки (р0,01). При сопоставлении данных перфузионной сцинтиграфии миокарда выявлена связь между показателем SSS, наличием факторов риска и наличием сопутствующих заболеваний у пациентов с ИБС (р0,05). Заключение. Перфузионная ОЭКТ миокарда может использоваться в качестве метода выявления преходящей ишемии миокарда у пациентов со стенозами КА различной тяжести. Ключевые слова: ишемическая болезнь сердца, однофотонная эмиссионная компьютерная томография, перфузия миокарда, сцинтиграфия миокарда, необструктивное поражение, обструктивное поражение, коронароангиография.Vulnerable atherosclerotic plaque in coronary arteries (CA) is the primary mechanism responsible for complications of CAD even in the terms of non-obstructive CAD. Early determination of myocardial ischemia and CA stenosis with non-invasive imaging technique could predict the development of major cardiac events in patients with CAD. Aim: evaluation the severity of myocardial perfusion defects with single photon emission computed tomography (SPECT) in patients with obstructive or non-obstructive CAD. Material and methods: Overall 231patients (average age of 6210) were analyzed. All patients underwent 1-day gated perfusion SPECT protocol before coronary angiography (CAG). SPECT images were quantified by SSS and SDS using Cedars-Sinai QPS. Normal myocardial perfusion was considered if SSS4 mildly abnormal: SSS4-7 moderate and significantly abnormal: SSS8-12 and SSS13, respectively. Reversible ischemia was defined as SDS2. Degree of ischemia was assessed to moderate (SDS2-7) and severe (SDS7). Obstructive CAD was defined as 50 stenosis in 1 vessel on CAG. Results: From 231 patients 69 (29,9) have non-significant CA stenosis (20), 126 (54,5) have non-obstructive CAD (20-49) and 36 (15,6) - obstructive CAD (50). There were significant differences between CA stenosis severity via CAG and SSS via SPECT. In obstructive CAD significant myocardial perfusion defect at stress (SSS) and reversible ischemia (SDS) were observed in 47,2 and 63,9 patients, respectively (p0,01). In patients with non-obstructive CAD although the majority has normal myocardial perfusion in stress (SSS4 55,6), 42,1 has both mild (25,4) and moderate (16,7) myocardial perfusion defects in stress (p0,001). In this subgroup 45,2 of patients have moderate and 18,3 - severe reversible ischemia according to SDS (p0,001). Abnormal perfusion in stress was associated with hazards of cardiac risk factors or associated diseases (p0,05). Conclusion: Perfusion SPECT has a prognostic value over invasive CAG. The addition SPECT quantitative analysis to CAG allows improved risk stratification of patients with non-obstructive CAD.

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