Normal limits of gated blood pool SPECT count-based regional cardiac function parameters

  • Kenneth J. Nichols
  • Andrew Van Tosh
  • Pieter De Bondt
  • Steven R. Bergmann
  • Christopher J. Palestro
  • Nathaniel Reichek
Original Paper


Purpose Computations of left and right ventricular (LV and RV) gated blood pool SPECT (GBPS) ejection fraction (EF) have been well validated against other imaging modalities. As GBPS images depict the entire extent of both blood pools, it is possible to compute not only global but also regional biventricular function parameters, which have the prospect of being clinically useful for planning cardiac resynchronization therapy. This investigation sought to establish LV and RV count-based GBPS regional functional normal limits and to quantify their reproducibility. Methods and materials Count-versus-time curves were fit to third-order Fourier series for each of 17 LV and RV sub-volumes to compute global and regional EF, timing, phase and dyssynchrony parameters. Algorithms were applied to data for 40 normal controls (NLs) and 15 patients with CHF. To assess reproducibility, data were reprocessed a second time, blinded to initial calculations. Results There were no statistically significant differences between any initial and reprocessed LV or RV parameters for NLs or patients with CHF. Percent of subjects categorized as abnormal were the same for initial and reprocessed parameters (McNemar’s differences = 0–7%, > 0.05 for each parameter). Most parameters were significantly different for patients with CHF versus NLs. Normal limits for the new technique agreed well with the literature for other imaging methods, and RV normal limits closely paralleled LV limits. Conclusion GBPS global and regional LV and RV normal limits are reproducible, and application of these normal limits to patients with CHF results in reproducible detection of functional abnormalities.


Heart function tests Radionuclide ventriculography Left ventricular hypertrophy Right ventricular hypertrophy 



We would like to thank Jing Han for her expert assistance with the statistical analysis reported for this report. This work received material support of the Saint Francis Cardiac Research Foundation. Kenneth Nichols shares in royalties for BP-SPECT algorithms.


  1. 1.
    Myers WO, Blackstone EH, Davis K, Foster ED, Kaiser GC (1999) CASS Registry long term surgical survival. Coronary artery surgery study. J Am Coll Cardiol 33(2):488–498PubMedCrossRefGoogle Scholar
  2. 2.
    Gregoratos G, Abrams J, Epstein AE et al (2002) ACC/AHA/NASPE (2002) guideline update for implantation of cardiac pacemakers and antiarrhythmia devices a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee on Pacemaker Implantation). Circulation 106:2145–2161PubMedCrossRefGoogle Scholar
  3. 3.
    Groch MW, Schippers DJ, Marshall RC, Groch PJ, Erwin WD (2002) Quantitative gated blood pool SPECT: analysis of 3-dimensional models for the assessment of regional myocardial wall motion. J Nucl Cardiol 9(3):271–284PubMedCrossRefGoogle Scholar
  4. 4.
    Nichols K, Saouaf R, Ababneh AA et al (2002) Validation of SPECT equilibrium radionuclide angiographic right ventricular parameters by cardiac MRI. J Nucl Cardiol 9:153–160PubMedCrossRefGoogle Scholar
  5. 5.
    Caresia-Aróztegui AP, Aguadé-Bruix S, Castell-Conesa J et al (2007) Gated-SPECT equilibrium radionuclide angiography in right ventricle assessment of patients with repaired tetralogy of Fallot. Nuc Med Comm 28(3):159–164CrossRefGoogle Scholar
  6. 6.
    Casset-Senon D, Philippe L, Babuty D et al (1998) Diagnosis of arrhythmogenic right ventricular cardiomyopathy by fourier analysis of gated blood pool single-photon emission tomography. Am J Cardiol 82:1399–1404PubMedCrossRefGoogle Scholar
  7. 7.
    Shah PK, Maddahi J, Staniloff HM et al (1986) Variable spectrum and prognostic implications of left and RV ejection fractions in patients with and without clinical heart failure after acute myocardial infarction. Am J Cardiol 58:387–393PubMedCrossRefGoogle Scholar
  8. 8.
    Dinu C, Klein G, Morestin-Cadet S et al (2006) Gated blood pool tomoscintigraphy with 4-dimensional optical flow motion analysis quantifies left ventricular mechanical activation and synchronization. J Nucl Cardiol 13(6):811–820PubMedCrossRefGoogle Scholar
  9. 9.
    Muramatsu T, Matsumoto K, Nishimura S (2005) Efficacy of the phase images in Fourier analysis using gated cardiac POOL-SPECT for determining the indication for cardiac resynchronization therapy. Circ J 69:1521–1526PubMedCrossRefGoogle Scholar
  10. 10.
    Akinboboye O, Nichols K, Wang Y, Dim UR, Reichek N (2005) Accuracy of radionuclide ventriculography assessed by magnetic resonance imaging in patients with abnormal left ventricles. J Nucl Cardiol 12(4):418–427PubMedCrossRefGoogle Scholar
  11. 11.
    De Bondt P, Nichols KJ, De Winter O et al (2006) Comparison among tomographic radionuclide ventriculography algorithms for computing left and right ventricular normal limits. J Nucl Cardiol 13(5):675–684PubMedCrossRefGoogle Scholar
  12. 12.
    Yu C-M, Abraham WT, Bax J et al (2005) Predictors of response to cardiac resynchronization therapy (PROSPECT) - study design. Am Heart J 49:600–605CrossRefGoogle Scholar
  13. 13.
    Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 18:539–542PubMedGoogle Scholar
  14. 14.
    O’Connell JW, Schreck C, Moles M et al (2005) A unique method by which to quantitate synchrony with equilibrium radionuclide angiography. J Nucl Cardiol 12(4):441–450PubMedCrossRefGoogle Scholar
  15. 15.
    Vilain D, Daou D, Casset-Senon D, Faraggi M, Le Guludec D (2001) Optimal 3-dimensional method for right and left ventricular Fourier phase analysis in electrocardiography-gated blood-pool SPECT. J Nucl Cardiol 8:371–378PubMedCrossRefGoogle Scholar
  16. 16.
    Chen J, Garcia EV, Folks RD et al (2005) Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Med 12(6):687–695Google Scholar
  17. 17.
    Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU (2003) Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Mag Res Imaging 17:323–329CrossRefGoogle Scholar
  18. 18.
    Thackray SDR, Ghosh JM, Wright GA et al (2006) The effect of altering heart rate on ventricular function in patients with heart failure treated with beta-blockers. Am Heart J 152(713):e9–e13PubMedGoogle Scholar
  19. 19.
    Henneman MM, Chen J, Dibbets-Schneider P et al (2007) Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 48(7):1104–1111PubMedCrossRefGoogle Scholar
  20. 20.
    Casset-Senon D, Babuty D, Alison D et al (2000) Delayed contraction area responsible for sustained ventricular tachycardia in an arrhythmogenic right ventricular cardiomyopathy: demonstration by Fourier analysis of SPECT equilibrium radionuclide angiography. J Nucl Cardiol 7:539–542PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Kenneth J. Nichols
    • 1
    • 2
    • 3
  • Andrew Van Tosh
    • 3
  • Pieter De Bondt
    • 4
  • Steven R. Bergmann
    • 5
  • Christopher J. Palestro
    • 1
    • 2
  • Nathaniel Reichek
    • 3
  1. 1.Division of Nuclear MedicineNorth Shore Long Island Jewish Health SystemNew Hyde ParkUSA
  2. 2.Division of Molecular ImagingNorth Shore Long Island Jewish Health SystemNew Hyde ParkUSA
  3. 3.Cardiac Imaging Research ProgramRoslynUSA
  4. 4.The Division of Nuclear MedicineOLV HospitalAalstBelgium
  5. 5.The Division of CardiologyBeth-Israel HospitalNew YorkUSA

Personalised recommendations