Assessment of LV diastolic dysfunction in myocardial perfusion imaging: a correlative study with transthoracic echocardiography.

OBJECTIVE: Myocardial perfusion imaging (MPI) by gated single-photon emission computed tomography (SPECT) is a feasible method in the evaluation of left ventricular perfusion and function. The purpose of this study was to determine the threshold and grading of left ventricular (LV) diastolic dysfunction (LVDD) using gated SPECT MPI. METHODS: A total of 149 patients were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study and transthoracic echocardiography within 2 weeks. The reconstructed rest-only images were analyzed by Cedar-Sinai's quantitative gated SPECT and the LV diastolic parameters, including peak filling rate (PFR), time to PFR (TTPF) and secondary PFR (PFR2) to PFR ratio were provided and compared to echocardiographic data. RESULTS: 68 (45.6%) and 81 (54.4%) of patients were categorized in LVDD-absent and LVDD-present groups on the basis of LVDD evidence in echocardiography, respectively. receiver-operating-characteristic analysis for PFR and TTPF was performed, resulting in diagnostic sensitivities of 70 and 57% and specificities of 60 and 75% for PFR <2.6 end-diastolic volumes (EDV)/s and TTPF>160.5 ms, respectively. Applying our previously used thresholds of <1.70 EDV/s for PFR, >208 ms for TTPF and >1 for PFR2/PFR, sensitivities and specificities of 9.9 and 96.6%, 9.9 and 95.6% and 13.8 and 88% were resulted, respectively. Grading of LVDD on the basis of MPI-obtained diastolic parameters showed considerable overlapping data by interquartile range. CONCLUSION: Gated SPECT MPI can be used as a highly specific means for detection of LV diastolic dysfunction when compared to echocardiography. However, grading of severity of diastolic heart failure appears to be impracticable.

Effects of filtration on right ventricular function by the gated blood pool SPECT.

OBJECTIVE: Gated blood po ol single photon emission computed tomography (GBPS) offers the possibility of obtaining additional functional information from blood pool studies, including evaluation of left and right ventricular function simultaneously. The calculation of ventricular volumes based on the identification of the endocardial surface would be influenced by the spatial resolution in the reconstructed images. This study was performed to evaluate the effect of different filters on the right ventricular function. METHODS: The normal four-dimensional (4-D) NURBS-based cardiac-torso (NCAT) phantom with known right ventricular volume and ejection fraction was generated. The SIMIND Monte Carlo program was used to create projections. The studies were reconstructed by FBP and post-processing filtration such as Butterworth, Hanning, Shepp-Logan, Metz and Wiener in different statuses (cutoff and order). Using the Cedars-Sinai QBS (quantitative blood pool SPECT) package, the ventricular functional parameters were computed. The calculated values were analyzed and compared with the normal NCAT results. RESULTS: The results implied that the calculated right ventricular end diastolic volume (RVEDV) by Butterworth filtration (cutoff frequency = 0.3) agreed more with the NCAT Phantom characteristics [relative difference percentage (RDP) = 1.2 %], while the maximum accordance in the calculation of the RV ejection fraction (EF) (RDP = 3 %) was observed by Metz filter (FWHM 20 pixel). Also, the results of this study demonstrate that the Butterworth filter provided the most stable values (cutoff frequency = 0.4-0.5) in the estimation of RVEDV (RDP = 7.5 %). The Hanning and Shepp-Logan filters produced a much larger RDP, particularly in low frequency (41.1 and 21.5 %, respectively) compared to other filters. CONCLUSIONS: This study demonstrated that the operation of different filters has a severe effect in computing right ventricular volume. The resolution recovery and Butterworth filters tend to give more comparable ventricular volumes with the actual normal NCAT value. Further evaluation using a large clinical database is underway to evaluate the optimum protocol in a clinical setting.

Influence of respiratory motion correction on quantification of myocardial perfusion SPECT.

BACKGROUND: Respiratory-related cardiac motion could have considerable effects on myocardial perfusion imaging, leading to misinterpretation of the images. In this study, we examined the influence of respiratory correction on ECG-gated myocardial perfusion SPECT (RC-GSPECT) concerning regional myocardial perfusion and function. MATERIALS AND METHODS: Using the NCAT phantom, a typical torso phantom was generated. SimSET, a Monte Carlo simulator, was used to image the photon emerging from the phantom. Twenty-six patients underwent a 2-day stress-rest ECG-gated myocardial perfusion SPECT (GSPECT) imaging. A separate study was also performed by simultaneous respiratory and cardiac triggering with the real-time position management (RPM) for respiratory correction (RC). RESULTS: In simulation study, count density in the inferior and inferoseptal walls increased in the lower bin of the respiratory cycle. On the other hand, there was a higher correlation between RC-GSPECT and echocardiography for left ventricular ejection fraction (LVEF) (r = 0.95, P < .01 vs r = 0.88, P < .01 for GSPECT). CONCLUSION: We proposed a new approach for respiratory and cardiac-gated SPECT to eliminate respiratory motion artifacts. RC-GSPECT is a feasible method in MPI studies and may play an important role to improve the quality of MPI images, particularly in the inferior wall.

Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: comparison between QGS and ECTb software packages.

BACKGROUND: Recently, the phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has become feasible via several software packages for the evaluation of left ventricular mechanical dyssynchrony. We compared two quantitative software packages, quantitative gated SPECT (QGS) and Emory cardiac toolbox (ECTb), with tissue Doppler imaging (TDI) as the conventional method for the evaluation of left ventricular mechanical dyssynchrony. METHODS AND RESULTS: Thirty-one patients with severe heart failure (ejection fraction ≤35%) and regular heart rhythm, who referred for gated-SPECT MPI, were enrolled. TDI was performed within 3 days after MPI. Dyssynchrony parameters derived from gated-SPECT MPI were analyzed by QGS and ECTb and were compared with the Yu index and septal-lateral wall delay measured by TDI. QGS and ECTb showed a good correlation for assessment of phase histogram bandwidth (PHB) and phase standard deviation (PSD) (r = 0.664 and r = 0.731, P < .001, respectively). However, the mean value of PHB and PSD by ECTb was significantly higher than that of QGS. No significant correlation was found between ECTb and QGS and the Yu index. Nevertheless, PHB, PSD, and entropy derived from QGS revealed a significant (r = 0.424, r = 0.478, r = 0.543, respectively; P < .02) correlation with septal-lateral wall delay. CONCLUSION: Despite a good correlation between QGS and ECTb software packages, different normal cut-off values of PSD and PHB should be defined for each software package. There was only a modest correlation between phase analysis of gated-SPECT MPI and TDI data, especially in the population of heart failure patients with both narrow and wide QRS complex.