Impact of imaging protocol on left ventricular ejection fraction using gated-SPECT myocardial perfusion imaging
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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.
Key WordsGated-SPECT myocardial perfusion imaging prognosis study protocol
Coronary artery disease
Myocardial perfusion imaging
Summed difference score
Summed rest score
Summed stress score
CMarcassa contributed in conception, design and analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript. R. Giubbini contributed in conception, design and analysis and interpretation of data; revising the manuscript critically for important intellectual content and final approval of the manuscript. W. Acampa contributed in conception, design and interpretation of data; drafting of the manuscript; final approval of the manuscript. C. Cittanti contributed by active involvement in collecting data; revising the manuscript critically for important intellectual content. A. Gimelli contributed in conception, design and interpretation of data; drafting of the manuscript; final approval of the manuscript. G. Medolago contributed by active involvement in collection and analysis/interpretation of data. E. Milan contributed in revising the manuscript critically for important intellectual content, final approval of the manuscript. R. Sciagrà contributed in revising the manuscript critically for important intellectual content and final approval of the manuscript. O. Djepaxhija contributed by active involvement in collection and analysis of data. A. Kokomani contributed by active involvement in collection and analysis of data.
The authors have indicated that they have no financial conflict of interest.
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