Diastolic filling parameters derived from myocardial perfusion imaging can predict left ventricular end-diastolic pressure at subsequent cardiac catheterization.
Morbidity and mortality increase when diastolic dysfunction accompanies coronary artery disease (CAD). An elevated stress (201)Tl lung-to-heart ratio (LHR) is a traditional marker of elevated left ventricular end-diastolic pressure (LVEDP), which adds prognostic value in CAD. Since the introduction of (99m)Tc-labeled agents, this valuable marker has been lost. Hence, there is only a limited ability to assess diastolic dysfunction by myocardial perfusion imaging (MPI).


METHODS
Fifty-two consecutive patients with an ejection fraction of >or=45% underwent MPI and cardiac catheterization within 15 d. Peak filling rate (PFR), time to PFR (TPFR), and filling rate during the first third of diastole (1/3FR) were obtained from MPI with SPECT software. Resting (201)Tl LHR was calculated manually, and LVEDP was obtained at catheterization.


RESULTS
PFR, TPFR, and 1/3FR correlated significantly with LVEDP (r= -0.53, 0.45, and -0.45, respectively; P=0.00005, 0.0009, and 0.0009, respectively), whereas resting (201)Tl LHR did not (r=0.10, P=0.49). Receiver-operating-characteristic curve analysis of PFR, TPFR, and 1/3FR for detecting LVEDPs of >or=18 mm Hg showed areas under the curve of 0.83, 0.75, and 0.80, respectively. The combination of PFR and 1/3FR showed a negative predictive value of 84%, a positive predictive value of 86%, and a specificity of 94%.


CONCLUSIONS
Diastolic filling variables obtained with the SPECT software showed a significant correlation with LVEDP. PFR, TPFR, and 1/3FR were superior to resting (201)Tl LHR and showed good sensitivity, specificity, and predictive power for detecting LVEDPs of >or=18 mm Hg. Hence, combining data on the presence of perfusion defects with data on diastolic impairments can be achieved by adding these variables to MPI results.
Patel
Dineshkumar
D
Section of Cardiology, Department of Medicine, Medical College of Georgia, Augusta, Georgia 30912, USA.
Robinson
Vincent J B
VJ
Arteaga
Roque B
RB
Thornton
John W
JW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation; D001794:Blood Pressure; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012146:Rest / Q000502:physiology; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
D013794:Thallium Radioisotopes