Left ventricular function in patients with coronary artery disease assessed by gated tomographic myocardial perfusion images. Comparison with assessment by contrast ventriculography and first-pass radionuclide angiography.
OBJECTIVE
This study evaluated the use of gated single-photon emission computed tomographic (SPECT) myocardial perfusion images for determination of left ventricular ejection fraction.


BACKGROUND
Gated SPECT has expanded the applications of myocardial perfusion imaging to include the evaluation of left ventricular size, regional wall motion and regional systolic thickening. Accurate automated or semi-automated methods for quantitation of left ventricular ejection fraction from tomographic perfusion images would provide additional valuable clinical information.


METHODS
Rest gated SPECT was performed on the stress distribution of technetium-99m sestamibi, using eight frames per cardiac cycle. Mid-horizontal long-axis and vertical long-axis gated tomographic perfusion images were analyzed after digital matrix inversion, which enhances edge detection, for ejection fraction determination. These ejection fractions were compared with those determined by contrast ventriculography (n = 54, including 45 biplane and 9 single plane) and first-pass radionuclide angiography (n = 38) in patients with coronary artery disease.


RESULTS
Myocardial perfusion SPECT image inversion-derived ejection fractions were slightly lower (2.7 ejection fraction units, p < 0.01), and first-pass ejection fractions were much lower (8.0 ejection fraction units, p < 0.001) than those obtained with contrast ventriculography. There was excellent correlation between SPECT and contrast ventriculographic ejection fractions (r = 0.93) over a wide range of ejection fractions (14% to 89%). Good correlation was also observed between first-pass radionuclide angiography and both contrast ventriculography (r = 0.83) and SPECT (r = 0.87). Reproducibility of SPECT image inversion ejection fractions was excellent (intraobserver r = 0.99, interobserver r = 0.93).


CONCLUSIONS
Semiautomated ejection fractions can be obtained from gated SPECT technetium-99m sestamibi perfusion images using the image inversion technique. These results are reproducible and correlate well with results of first-pass radionuclide angiography but are closer in value to those obtained with contrast ventriculography.
Department of Medicine (Cardiology), University of Chicago, Illinois 60637, USA.
K A
KA
Williams
L A
LA
Taillon
D000368:Aged; D000465:Algorithms; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012044:Regression Analysis; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left / Q000502:physiology*; D015646:Ventriculography, First-Pass
D017256:Technetium Tc 99m Sestamibi