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Significance of Increased Right Ventricular Uptake on ^99mTc-Sestamibi SPECT in Patients with Coronary Artery Disease

Department of Radiology, Division of Nuclear Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: Finn Mannting, MD, PhD, Division of Nuclear Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02155.

ABSTRACT

The significance of increased right ventricular (RV) tracer uptake inpatients with coronary artery disease (CAD) without pulmonary or valvular heart disease is unclear. Methods: Forty consecutive patients with increased RV uptake on SPECT myocardial perfusion imaging and right heart catheterization within 4 wk were studied prospectively. Thirty-five individuals with very low likelihood of CAD served as controls. Rest and stress SPECT myocardial perfusion data were obtained using a standard ^99mTc-sestamibi 1-d imaging protocol. A quick and simple RV-to left ventricular (LV) myocardial uptake ratio was calculated from the maximum counts per pixel detected in the right and left ventricles using there constructed coronal slices. RV end-systolic pressure (RV-ESP), mean pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure were obtained by standard techniques. Results: The RV/LV uptake ratio in the controls was 0.31 ± 0.05. Thirty-six of the 40 (90%) CAD patients with increased RV tracer uptake had increased RV-ESP, and 39 (97.5%) had increased PAP. Highly significant positive correlations between the RV/LV uptake ratio and RV-ESP and PAP were found (r = 0.45, P = 0.003; and r = 0.52, P < 0.001, respectively) Conclusion: Increased RV uptake, assessed from standard myocardial perfusion studies, can identify RV pressure overload among patients with CAD. In the absence of pulmonary or valvular heart disease, increased RV uptake (i.e., RV pressure overload) indicates significant backward failure, a variable with known significant negative prognostic implications.

Key Words: right ventricle • myocardial perfusion • SPECT • sestamibi

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