title: Detection of occult left ventricular dysfunction in patients without prior clinical history of myocardial infarction by technetium-99m sestamibi myocardial perfusion gated single-photon emission computed tomography.
abstract: BACKGROUND
  In the absence of a prior history of myocardial infarction (MI), left ventricular (LV) dysfunction is commonly due to hypertension, valvular heart disease, or hibernating myocardium.
  
  
  OBJECTIVE
  Since technetium-99m sestamibi gated single-photon emission computed tomography (SPECT) may be used to determine both stress/rest myocardial perfusion and resting LV function, we attempted to evaluate the ability of gated SPECT imaging to detect occult LV dysfunction.
  
  
  METHODS
  We evaluated the ability of this technique to detect occult LV dysfunction among 179 patients without history MI and angiographically documented coronary artery disease (CAD). All patients underwent both gated SPECT and cardiac catheterization within a 6-month time period. Left ventricular volume and ejection fraction (EF) values were determined according to a previously validated technique using Simpson's rule. Normal limit values for LV volumes and EF were derived from a control population of 93 patients with normal coronary angiograms.
  
  
  RESULTS
  Based on normal limit-derived criteria, 15% of the CAD study cohort had occult LV dysfunction (> 2 standard deviations below gender-specific normal limit means for LVEF). Mean LV end-diastolic volume index (EDVi) was significantly increased (p < 0.05) and LVEF decreased (p < 0.05) in patients with triple-vessel CAD. End-diastolic volume index was also increased in the cohort of patients with both hypertension and LV hypertrophy (LVH) (p < 0.05). However, multivariate logistic regression analysis revealed that only CAD extent, but not hypertension or LVH, was a significant predictor of occult LV dysfunction (p = 0.009).
  
  
  CONCLUSIONS
  Occult LV dysfunction can be detected in patients with CAD by gating technetium-99m sestamibi SPECT studies, and its presence may signify the presence of extensive CAD.
authors.affiliation: Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10019, USA. sy212@columbia.edu
authors.forename: Shu-Sun
authors.initials: SS
authors.lastname: Yao
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nichols
authors.forename: E Gordon
authors.initials: EG
authors.lastname: DePuey
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi