title: Stress-induced myocardial ischemia is associated with early post-stress left ventricular mechanical dyssynchrony as assessed by phase analysis of 201Tl gated SPECT myocardial perfusion imaging.
abstract: OBJECTIVE
  In (201)Tl SPECT myocardial perfusion imaging (MPI) data are acquired shortly after the stress injection to assess early post-stress left ventricle (LV) function. The purpose of this study was to use (201)Tl SPECT MPI to investigate whether stress-induced myocardial ischemia is associated with LV mechanical dyssynchrony.
  
  
  METHODS
  Enrolled in the study were 75 patients who were referred for dipyridamole stress and rest (201)Tl gated SPECT MPI. The early post-stress scan was started 5 min after injection, and followed by the rest scan 4 h later. The patients were divided into three groups: ischemia group (N = 25, summed stress score, SSS, ≥5, summed rest score, SRS, <5), infarct group (N = 16, SSS ≥5, SRS ≥5) and normal group (N = 34, SSS <5, SRS <5). LV dyssynchrony parameters were calculated by phase analysis, and compared between the stress and rest images.
  
  
  RESULTS
  In the ischemia group, LV dyssynchrony was significantly larger during stress than during rest. On the contrary, LV dyssynchrony during stress was significantly smaller than during rest in the normal and infarct groups. LV dyssynchrony during rest was significantly larger in the infarct group than in the normal and ischemia groups. There were no significant differences in LV dyssynchrony during rest between the normal and ischemia groups.
  
  
  CONCLUSIONS
  Stress-induced myocardial ischemia caused dyssynchronous contraction in the ischemic region, leading to a deterioration in LV synchrony. Normal myocardium had more synchronous contraction during stress. The different dyssynchrony pattern between ischemic and normal myocardium early post-stress may aid the diagnosis of coronary artery disease using (201)Tl gated SPECT MPI.
authors.affiliation: Department of Cardiology, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Chen
authors.forename: Thau-Yun
authors.initials: TY
authors.lastname: Shen
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Chang
authors.forename: Guang-Uei
authors.initials: GU
authors.lastname: Hung
authors.forename: Wan-Chen
authors.initials: WC
authors.lastname: Chen
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
mesh_terms: D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D004176:Dipyridamole / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D019275:Radiopharmaceuticals; D013312:Stress, Physiological; D013793:Thallium; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D016276:Ventricular Function / Q000187:drug effects
chemical_list: D019275:Radiopharmaceuticals; C027549:thallium chloride; D004176:Dipyridamole; D013793:Thallium