Significance of increased right ventricular uptake on 99mTc-sestamibi SPECT in patients with coronary artery disease.
The significance of increased right ventricular (RV) tracer uptake in patients with coronary artery disease (CAD) without pulmonary or valvular heart disease is unclear.


METHODS
Forty consecutive patients with increased RV uptake on SPECT myocardial perfusion imaging and right heart catheterization within 4 wk were studied prospectively. Thirty-five individuals with very low likelihood of CAD served as controls. Rest and stress SPECT myocardial perfusion data were obtained using a standard 99mTc-sestamibi 1-d imaging protocol. A quick and simple RV-to-left ventricular (LV) myocardial uptake ratio was calculated from the maximum counts per pixel detected in the right and left ventricles using the reconstructed coronal slices. RV end-systolic pressure (RV-ESP), mean pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure were obtained by standard techniques.


RESULTS
The RV/LV uptake ratio in the controls was 0.31+/-0.05. Thirty-six of the 40 (90%) CAD patients with increased RV tracer uptake had increased RV-ESP, and 39 (97.5%) had increased PAP. Highly significant positive correlations between the RV/LV uptake ratio and RV-ESP and PAP were found (r = 0.45, P = 0.003; and r = 0.52, P < 0.001, respectively).


CONCLUSIONS
Increased RV uptake, assessed from standard myocardial perfusion studies, can identify RV pressure overload among patients with CAD. In the absence of pulmonary or valvular heart disease, increased RV uptake (i.e., RV pressure overload) indicates significant backward failure, a variable with known significant negative prognostic implications.
Mannting
F
F
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02155, USA.
Zabrodina
Y V
YV
Dass
C
C
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D011669:Pulmonary Wedge Pressure; D015635:Radionuclide Ventriculography; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi