title: Impact of imaging protocol on left ventricular ejection fraction using gated-SPECT myocardial perfusion imaging.
abstract: There are limited data on the impact of the imaging protocol (single-day stress-rest, SD, vs. dual-day, DD) on the change in left ventricular (LV) ejection fraction (EF) (post-stress-rest) in relation to ischemia and on outcome.
  
  
  
  Using propensity score matching procedure, 490 of 1121 patients with known CAD, undergoing a SD or a DD in a multicenter study, were evaluated. Stress and rest gated-SPECT myocardial perfusion imaging was used to quantify LV perfusion, EF, and volumes. Outcome was assessed at an average follow-up time of 3.2 years.
  
  
  
  Post-stress LVEF in SD and DD were comparable across all degrees of ischemia. The change in LVEF in patients with severe ischemia was, however, higher in the DD protocol, independent of the extent of CAD. At follow-up, 240 patients (49.0%) required coronary revascularization (CR) and 52 patients (10.6%) had hard events. The ischemic burden was independently associated with CR and hard-events; the post-stress LVEF was associated with CR but the change in EF was not predictive of either CR or hard events.
  
  
  
  In patients with severe ischemia, underestimation of post-stress myocardial stunning could be observed with the SD protocol. Post-stress LVEF and the extent ischemia, but not the change in EF, are predictive of CR and hard events.
authors.affiliation: Cardiology Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno, Veruno, Italy. claudio.marcassa@fsm.it.
authors.forename: C
authors.initials: C
authors.lastname: Marcassa
authors.affiliation: Department of Medical Imaging, University and Spedali Civili, Brescia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Giubbini
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Acampa
authors.affiliation: Nuclear Medicine Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cittanti
authors.affiliation: Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Djepaxhija
authors.affiliation: Fondazione Toscana G. Monasterio, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gimelli
authors.affiliation: Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kokomani
authors.affiliation: Nuclear Medicine Dept, Bergamo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Medolago
authors.affiliation: Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Milan
authors.affiliation: Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Sciagrà
mesh_terms: D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D002985:Clinical Protocols; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Gated-SPECT; myocardial perfusion imaging; prognosis; study protocol