Does motion analysis in postexercise gated sestamibi SPECT reflect rest left ventricular motion even in severe coronary artery disease?
OBJECTIVE
Evidence has suggested that postexercise gated Tc-99m sestamibi SPECT (GSPECT) provides combined information about resting wall motion and exercise perfusion. No data have been published about possible differences in wall motion analysis between postexercise and resting GSPECT.


METHODS
Fifty patients underwent postexercise (symptom-limited bicycle stress) and rest GSPECT and cardiac catheterization with contrast ventriculography. In 35 patients, additional rest planar Tc-99m RBC radionuclide ventriculography (RNV) was performed. Four observers independently performed left ventricular ejection fraction (LVEF) calculations and visual analysis of regional wall motion (graded in four stages) for all studies.


RESULTS
The LVEF calculations in GSPECT revealed a statistically significant difference between postexercise (45.8 +/- 15.7%) and rest (48.0 +/- 16.1%; P < 0.05) determination. Postrest GSPECT LVEF showed a better correlation with LVEF determination performed with contrast ventriculography and RNV than did postexercise GSPECT LVEF. The reduced postexercise wall motion could be shown in segments with exercise-induced ischemia and in those with normal regional perfusion but not in segments with irreversibly abnormal perfusion.


CONCLUSIONS
Postexercise GSPECT provides reliable information regarding global wall motion even in severe coronary artery disease, but regional wall motion is underestimated compared with rest GSPECT, because of an imprecise surface detection algorithm in ischemic wall segments and possibly postexercise stunning in severe coronary artery disease.
Leitha
T
T
University Clinic Nuclear Medicine, Vienna, Austria. THOMAS.LEITHA@akh-wien.ac.at
Gwechenberger
M
M
Pruckmayer
M
M
Staudenherz
A
A
Bailer
H
H
Kronik
G
G
D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis; D005080:Exercise Test; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D015588:Observer Variation; D011336:Probability; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology
D003287:Contrast Media; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi