Integración de los parámetros de remodelado, sincronía y velocidad máxima de vaciado para evaluar la función sistólica del ventrículo izquierdo / Integration of ventricular remodeling, synchrony and filling rate parameters to improve the assessment of left ventricular systolic function

Objetivos El objetivo es estudiar la relación entre los parámetros estructurales, de remodelado, de sincronía y de función sistólica del ventrículo izquierdo (VI) mediante gSPECT. Obtener los valores de corte del VI para el índice de la forma telediastólica (iFTD), el índice de la forma telesistólica (iFTS), el índice de excentricidad (iEX) y la velocidad máxima de vaciado (VMV). Desarrollar un nuevo índice para evaluar diferentes patrones de función sistólica del VI. Material y métodos Analizamos prospectivamente 238 pacientes (edad: 63,4±13 años) estudiados mediante gSPECT de esfuerzo-reposo (grupo-control, n=148; pacientes con infarto de miocardio [IM] previo, n=90). Estudio aprobado por el Comité de Ética del Hospital (PR[AG]168.2010). Resultados En el grupo-control, el índice del volumen telediastólico (iVTD) y el iEX influyeron en el iFTD (r2: 0,52, p<0,001). El iVTD, la VMV, ser varones y el iEX (r2: 0,44; p<0,001) influyeron en el iFTS. El iFTD, iFTS, la fracción de eyección VI (FEVI) y el volumen de eyección sistólica (r2: 0,62; p<0,001) influyeron en el iEX. La FEVI, la frecuencia cardíaca, el ancho de banda (AB) y la desviación estándar influyeron (r2: 0,76; p<0,001) en la VMV. Los valores de corte para iFTD, iFTS, iEX y VMV fueron 0,59, 0,42, 0,87 y −3,3 respectivamente. La VMV, el iFTS y el AB fueron los parámetros mejor relacionados con los pacientes con IM previo (AUC: 0,89), y sumados a la FEVI permitieron obtener distintos patrones de función sistólica (índice PERRS). Conclusiones Los parámetros de remodelado, sincronía y función sistólica del VI deben interpretarse simultáneamente, ya que esto permite obtener distintos patrones de función sistólica del VI (AU)

Introduction and objectives The aim of this study is to assess the relationship between structural, remodeling, synchrony, and systolic left ventricular (LV) function parameters using gated-SPECT myocardial-perfusion-images (gSPECT-MPI). In addition, obtaining the cut-off values for end-diastolic LV-shape-index (EDLVsi), end-systolic LV-shape-index (ESLVsi), ECC (eccentricity-index) and PER, and developing a new index to evaluate different patterns of the LV systolic function. Methods The study was approved by the Hospital's Ethical-Committee (PR[AG]168.2010), and all patients gave their informed consent. We analyzed prospectively 238 patients (age 63.4±13 years) who underwent stress-rest gSPECT-MPI (control-group, n=148; patients with previous myocardial infarction [MI], n=90). Results In the control group, with regard to remodeling parameters: the end-diastolic-volume-index (EDV) and the ECC were the parameters that influenced the EDLVsi (r2: 0.52, P<.001). EDV, PER, men, and the ECC were the parameters (r2: 0.44; P<.001) which influenced the ESLVsi. EDLVsi, ESLVsi, LVEF and the stroke-volume were the parameters (r2: 0.62; P<.001) which influenced the ECC. With regards to PER: LVEF, heart-rate, bandwidth, and the standard-deviation were the influencing parameters (r2: 0.76; P<.001). The cut-off values for EDLVsi, ESLVsi, ECC, and PER were 0.59, 0.42, 0.87, and 3.3, respectively. The PER, the ESLVsi and the bandwidth were the parameters related to patients with previous MI (AUC: 0.89); and they allow the assessment of different patterns of systolic function (PERRS-index: Peak-Emptying-Rate, left ventricular-Remodeling and Synchrony). Conclusions The remodeling, synchrony and the systolic function parameters of the LV should be interpreted together (PERRS-index). In this way, we obtain different patterns of LV systolic function (AU)

Integration of ventricular remodeling, synchrony and filling rate parameters to improve the assessment of left ventricular systolic function.

INTRODUCTION AND OBJECTIVES: The aim of this study is to assess the relationship between structural, remodeling, synchrony, and systolic left ventricular (LV) function parameters using gated-SPECT myocardial-perfusion-images (gSPECT-MPI). In addition, obtaining the cut-off values for end-diastolic LV-shape-index (EDLVsi), end-systolic LV-shape-index (ESLVsi), ECC (eccentricity-index) and PER, and developing a new index to evaluate different patterns of the LV systolic function. METHODS: The study was approved by the Hospital's Ethical-Committee (PR[AG]168.2010), and all patients gave their informed consent. We analyzed prospectively 238 patients (age 63.4 ±â€¯13 years) who underwent stress-rest gSPECT-MPI (control-group, n = 148; patients with previous myocardial infarction [MI], n = 90). RESULTS: In the control group, with regard to remodeling parameters: the end-diastolic-volume-index (EDV) and the ECC were the parameters that influenced the EDLVsi (r2: 0.52, p < 0.001). EDV, PER, men, and the ECC were the parameters (r2: 0.44; p < 0.001) which influenced the ESLVsi. EDLVsi, ESLVsi, LVEF and the stroke-volume were the parameters (r2: 0.62; p < 0.001) which influenced the ECC. With regards to PER: LVEF, heart-rate, bandwidth, and the standard-deviation were the influencing parameters (r2: 0.76; p < 0.001). The cut-off values for EDLVsi, ESLVsi, ECC, and PER were 0.59, 0.42, 0.87, and 3.3, respectively. The PER, the ESLVsi and the bandwidth were the parameters related to patients with previous MI (AUC: 0.89); and they allow the assessment of different patterns of systolic function (PERRS-index: peak-emptying-rate, left ventricular-remodeling and synchrony). CONCLUSIONS: The remodeling, synchrony and the systolic function parameters of the LV should be interpreted together (PERRS-index). In this way, we obtain different patterns of LV systolic function.

BDNF levels and nigrostriatal degeneration in "drug naïve" Parkinson's disease patients. An "in vivo" study using I-123-FP-CIT SPECT.

INTRODUCTION: Parkinson's Disease (PD) is a common neurodegenerative disorder, characterized by a progressive loss of dopaminergic neurons and whose cause remains unclear. Brain-Derived Neurotrophic factor (BDNF) is a protein involved in dopaminergic cells survival. Previous studies have shown decreased serum BDNF levels in PD patients. AIM AND OBJECTIVES: The aim of the study was to evaluate serum BDNF levels in a group of recently diagnosed non-medicated PD patients and its relationship with the nigrostriatal system degeneration using I-123-FP-CIT. METHODS: 30 recently diagnosed, unmedicated PD patients were included in this study. Serum BDNF levels were measured twice using a sandwich enzyme linked immunoabsorbent assay and compared with levels of 27 unrelated Caucasian healthy adults. A I-123-FP-CIT SPECT was performed in all PD Patients in order to assess the association between serum BDNF levels and I-123-FP CIT uptake in several brain areas using a volumetric semi-automatic method. RESULTS: PD patients showed lower serum BDNF levels (Median = 49.61, IQ range: 43.55 to 61.82) than the controls (Median = 68.82, IQ range: 51.87 to 88.14) (U = 211.00, z = -3.10, p = 0.002). BDNF levels in PD patients correlated with both caudate (Spearman r = 0.58, p = 0.001 for ispilateral and r 0.55, p = 0.002 for contralateral) and putamen (Spearman r = 0.68, p < 0.001 for ipsilateral and r = 0.80, p < 0.001 for contralateral) I-123-FP-CIT uptake ratios. CONCLUSIONS: Serum BDNF levels were lower in recently diagnosed, untreated PD patients compared to controls. These lower levels were significantly correlated with the I-123-FP-CIT uptake ratios.

Detección de tejido paratiroideo hiperfuncionante mediante PET/TC con 18F-fluorocolina / Detection of hyperfunctioning parathyroid tissue by 18F-Fluorocholine PET/CT

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SPECT, angio-TC coronaria, coronariografía invasiva e imágenes de fusión en la cardiopatía isquémica estable / SPECT, coronary angio-CT, invasive coronary angiography and fusion images in stable coronary disease

Objetivos: Valorar la información de la SPECT, de la angio-TC coronaria y de las imágenes híbridas de fusión en los pacientes con cardiopatía isquémica estable en los que se practica una coronariografía invasiva (CI). Material y métodos: Se ha incluido en forma prospectiva a 46 pacientes (65,98 ± 8,3 años) con enfermedad coronaria, valorándose la información de dichas técnicas en el diagnóstico de la enfermedad multivaso, en la detección del vaso culpable y en el manejo de los pacientes. Resultados: En la CI, 29 de los 46 pacientes (63%) presentaban enfermedad multivaso: la SPECT la diagnosticó en un 48,2% y la angio-TC en un 89,6%. La concordancia entre la angio-TC y la CI en el diagnóstico del vaso culpable fue del 77% (kappa 0,6) y entre la SPECT y la CI del 73% (kappa 0,56). Las imágenes híbridas obtenidas después del cateterismo no habrían aportado nueva información a la ya obtenida mediante la SPECT y la CI de cara al manejo terapéutico. Conclusiones: La angio-TC destaca en el diagnóstico de la enfermedad multivaso y en la detección del vaso culpable respecto a la CI. La SPECT resulta un buen complemento funcional de la CI en la detección del territorio más isquémico. No obstante, en los pacientes con cardiopatía isquémica estable en los que se ha realizado una SPECT como primer estudio no invasivo, si la decisión de practicar posteriormente una CI es clara, la realización de una angio-TC y la obtención de imágenes de fusión SPECT-TC no parecen indicadas, ya que no cambiaría el manejo terapéutico que se adopta sobre la base de la información de la SPECT y la CI (AU)

Objectives: To evaluate the usefulness of the information obtained with SPECT, coronary angio-CT and fusion images, in patients with stable ischemic disease who need invasive coronary angiography (IA). Material and methods: Forty-six patients (65.98 ± 8.3 years) with coronary disease were prospectively included. The fusion images generated after undergoing IA were used to evaluate the performance of these techniques in the diagnosis of multi-vessel coronary disease, the detection of the culprit vessel and the therapeutic management of these patients. Results: In the IA, 29 of the 46 patients (63%) had multi-vessel disease. SPECT could detect it in 48.2% and coronary angio-CT could detect it in 89.6%. Concordance between coronary angio-CT and IA in the diagnosis of the culprit vessel was 77% (kappa 0.6), and between SPECT and IA it was 73% (kappa 0.56). Although fusion images could have been obtained prior to IA, they would not have changed the therapeutic approach derived from SPECT and IA. Conclusions: Coronary angio-CT has a high ability for the diagnosis of multi-vessel disease and the culprit lesion, and SPECT is a good functional complement of the IA in the detection of the most ischemic territory. However, the performance of fusion images in patients with stable ischemic disease, who have undergone a SPECT as the first non-invasive study and need IA, does not seem indicated because they would not have changed the therapeutic management derived from SPECT and IA information (AU)

Unilateral breast metastasis from alveolar rhabdomyosarcoma in adult detected by 18F-FDG PET/CT / Metástasis mamaria unilateral de rabdomiosarcoma alveolar en un adulto, detectada por 18F-FDG PET/TAC

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[SPECT, coronary angio-CT, invasive coronary angiography and fusion images in stable coronary disease]. / SPECT, angio-TC coronaria, coronariografía invasiva e imágenes de fusión en la cardiopatía isquémica estable.

OBJECTIVES: To evaluate the usefulness of the information obtained with SPECT, coronary angio-CT and fusion images, in patients with stable ischemic disease who need invasive coronary angiography (IA). MATERIAL AND METHODS: Forty-six patients (65.98±8.3 years) with coronary disease were prospectively included. The fusion images generated after undergoing IA were used to evaluate the performance of these techniques in the diagnosis of multi-vessel coronary disease, the detection of the culprit vessel and the therapeutic management of these patients. RESULTS: In the IA, 29 of the 46 patients (63%) had multi-vessel disease. SPECT could detect it in 48.2% and coronary angio-CT could detect it in 89.6%. Concordance between coronary angio-CT and IA in the diagnosis of the culprit vessel was 77% (kappa 0.6), and between SPECT and IA it was 73% (kappa 0.56). Although fusion images could have been obtained prior to IA, they would not have changed the therapeutic approach derived from SPECT and IA. CONCLUSIONS: Coronary angio-CT has a high ability for the diagnosis of multi-vessel disease and the culprit lesion, and SPECT is a good functional complement of the IA in the detection of the most ischemic territory. However, the performance of fusion images in patients with stable ischemic disease, who have undergone a SPECT as the first non-invasive study and need IA, does not seem indicated because they would not have changed the therapeutic management derived from SPECT and IA information.

18F-FDG PET-CT usefulness in extra-pancreatic involvement in IgG4 related diseases / Utilidad de la 18F-FDG PET-TC en las manifestaciones extrapancreáticas de las enfermedades relacionadas con IgG4

IgG4-related diseases are a group of recently identified entities that include disorders that were previously known by other names, such as Mikulicz disease, Küttner's tumor, Riedel thyroiditis, among others, as well as some new ones described in the last years. These pathologies are a challenge for the medical community in terms of diagnosis and characterization due to their wide spectrum of clinical presentation. Functional imaging can provide a new approach to the comprehension of physiopathology, staging and targeting site of biopsy of IgG4-related diseases. In this clinical note, we describe five patients who underwent 18F-FDG PET-CT and correlate their findings with previous reports (AU)

Las enfermedades relacionadas con IgG4 son un grupo de entidades recientemente identificadas; que engloban a patologías anteriormente conocidas como la enfermedad de Mikulicz, el tumor de Küttner y la tiroiditis de Riedel entre otras, las cuales se creían que eran entidades diferentes, y otras descritas en los últimos años. Estas patologías plantean un reto diagnóstico para el clínico y el médico nuclear, dado su amplio espectro de presentación clínica. La imagen funcional puede brindar un nuevo abordaje con respecto a la fisiopatología, estudio de extensión y optimización de los sitios de biopsia, en las enfermedades relacionadas con IgG4. En esta nota clínica presentamos cinco 5 casos clínicos, valorados mediante 18F-FDG PET-TC y correlacionamos hallazgos con la literatura médica reciente (AU)

¹8F-FDG PET-CT usefulness in extra-pancreatic involvement in IgG4 related diseases.

IgG4-related diseases are a group of recently identified entities that include disorders that were previously known by other names, such as Mikulicz disease, Küttner's tumor, Riedel thyroiditis, among others, as well as some new ones described in the last years. These pathologies are a challenge for the medical community in terms of diagnosis and characterization due to their wide spectrum of clinical presentation. Functional imaging can provide a new approach to the comprehension of physiopathology, staging and targeting site of biopsy of IgG4-related diseases. In this clinical note, we describe five patients who underwent ¹8F-FDG PET-CT and correlate their findings with previous reports.

Authors' reply to "Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction" / Réplica a "Análisis de la función diastólica mediante gated-SPECT de perfusión miocárdica tras revascularización coronaria en el infarto agudo de miocardio"

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La tomografía por emisión de positrones-tomografía computarizada con 18F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina / Positron emission tomography-computed tomography with 18F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels

Objetivo. Evaluar el rendimiento diagnóstico de la PET-TC con 18F-FDG y su relación con los niveles séricos de tiroglobulina (Tg) en los pacientes con cáncer diferenciado de tiroides con sospecha de persistencia o recurrencia de enfermedad y rastreo con radioyodo negativo. Material y métodos. Análisis retrospectivo de 35 estudios PET-TC en 25 pacientes (17 mujeres, edad media 48,8±15,2 años). Los resultados se comprobaron histológicamente, o mediante ecografía y seguimiento clínico. Se analizó la relación entre el rendimiento diagnóstico de la PET-TC y 3 niveles de Tg: ≤2ng/ml; entre 2 y 10 ng/ml, y >10ng/ml. Resultados. Se obtuvieron 26 verdaderos positivos, un falso positivo, 3 verdaderos negativos y 5 falsos negativos. De los 18 pacientes con una PET-TC clasificada como verdadero positivo, 3 mostraron lesiones en el lecho postiroidectomía, 15 mostraron afectación ganglionar y 5 presentaron metástasis a distancia. La sensibilidad fue del 83,9% (IC95%: 69,3-98,4%) y la especificidad del 75% (IC95%: 20-100%). Para 3 intervalos de Tg, la PET-TC mostró una tasa de verdaderos positivos del 37,5, del 83 y del 100% en los pacientes con niveles de Tg <2, entre 2 y 10, y >10 ng/ml, respectivamente. Conclusiones. La PET-TC con 18F-FDG muestra un alto rendimiento diagnóstico de la enfermedad locorregional y a distancia en la población de pacientes con cáncer diferenciado de tiroides en situación de persistencia de enfermedad y rastreo con yodo negativo con niveles de Tg >2ng/ml(AU)

Objective. To assess the diagnostic performance of 18F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. Materials and methods. This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. Results. We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. Conclusions. 18F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml(AU)

Análisis de la función diastólica mediante gated-SPECT de perfusión miocárdica tras revascularización coronaria en el infarto agudo de miocardio / Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction

Objetivo. Valorar mediante gated-SPECT de perfusión miocárdica los cambios evolutivos de la función diastólica después de la revascularización coronaria percutánea (RCP) de un infarto agudo de miocardio (IAM). Material y métodos. Se estudiaron consecutivamente 32 pacientes (media 61,9±9,7 años; 7 mujeres) mediante 2 gated-SPECT de perfusión miocárdica en reposo: la primera gated-SPECT-1 con inyección de una dosis de 99mTc-tetrofosmina previa a la RCP y la segunda gated-SPECT-2 entre la cuarta y quinta semana después del IAM. Se valoraron los cambios de la velocidad máxima de llenado (Vmáx) y del tiempo a la velocidad máxima de llenado (TVmáx) entre ambos estudios, relacionándolos con la extensión del miocardio salvado (MS) y con los cambios observados en los volúmenes telediastólico (VTD) y telesistólico (VTS) y en la fracción de eyección del ventrículo izquierdo (FEVI). Resultados. En la gated-SPECT-2 se observó una mejoría de los parámetros de la función diastólica: la Vmáx aumentó significativamente (p = 0,011) mientras que el TVmáx disminuyó sin alcanzar significación estadística (p = 0,288). En el análisis multivariante, ajustado por variables clínicas y coronariográficas, el aumento de la Vmáx se relacionó significativamente con el porcentaje de MS (p = 0,030), el aumento de la FEVI (p = 0,004) y la reducción del VTS (p = 0,005). La mejoría del TVmáx solo se relacionó significativamente con el porcentaje de MS (p = 0,046). Por cada cm2 de aumento del área del MS la Vmáx aumentó 0,01 VTD/s y la TVmáx disminuyó 1,14 ms. Conclusiones. Tras la RCP en el IAM, la gated-SPECT de perfusión miocárdica permite valorar la mejoría significativa de la función diastólica que se relaciona fundamentalmente con la cantidad de MS (AU)

Objective. To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT. Material and methods. Thirty-two patients (mean 61.9±9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of 99mTc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes. Results. An improvement was observed in diastolic function parameters Gated-SPECT-2: PFR increased significantly (P=0.011) while the TTPF decreased without reaching statistical significance (P=0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (P=0.030), increase in LVEF (P=0.004) and with ESV volume reduction (P=0.005). Improvement of TTPF was only related significantly to the percentage of SM (P=0.046). PFR increased 0.01 EDV/sec. and TTPF decreased 1.14ms for each cm2 increase of the area of SM. Conclusions. After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS (AU)

[Positron emission tomography-computed tomography with (18)F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels]. / La tomografía por emisión de positrones-tomografía computarizada con (18)F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina.

OBJECTIVE: To assess the diagnostic performance of (18)F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. MATERIALS AND METHODS: This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. RESULTS: We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. CONCLUSIONS: (18)F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml.

[Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction]. / Análisis de la función diastólica mediante gated-SPECT de perfusión miocárdica tras revascularización coronaria en el infarto agudo de miocardio.

OBJECTIVE: To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT. METHODS: Thirty-two patients (mean 61.9±9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of (99m)Tc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes. RESULTS: An improvement was observed in diastolic function parameters Gated-SPECT-2: PFR increased significantly (P=0.011) while the TTPF decreased without reaching statistical significance (P=0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (P=0.030), increase in LVEF (P=0.004) and with ESV volume reduction (P=0.005). Improvement of TTPF was only related significantly to the percentage of SM (P=0.046). PFR increased 0.01 EDV/sec. and TTPF decreased 1.14ms for each cm(2) increase of the area of SM. CONCLUSIONS: After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS.