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Development and Application of Normal Limits for Left Ventricular Ejection Fraction and Volume Measurements from ^99mTc-Sestamibi Myocardial Perfusion Gated SPECT

Division of Cardiology, Department of Medicine, and Division of Nuclear Medicine, St. Luke's-Roosevelt Hospital Center, New York
Departments of Medicine and Radiology, Columbia University College of Physicians and Surgeons, New York, New York

Correspondence: For correspondence or reprints contact: Alan Rozanski, MD, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, 114th St. and Amsterdam Ave., New York, NY 10025.

ABSTRACT

Gated SPECT is a reproducible method for assessing left ventricular volume (LVV) and left ventricular ejection fraction (LVEF) from ^99mTc-sestamibi myocardial perfusion imaging studies. LW and LVEF measurements by this approach correlate well with those obtained from other cardiovascular imaging techniques. Nevertheless, the lack of criteria for abnormal test findings has limited the potential clinical application of this new imaging technique. Methods: Gated SPECT measurements were evaluated for 214 patients with a low Bayesian likelihood (<10%) of coronary artery disease (CAD) before performance of ^99mTc-sestamibi stress-rest myocardial perfusion SPECT. The patients were grouped into normotensive patients (n = 98), hypertensive patients without left ventricular hypertrophy (LVH) (n = 80), and hypertensive patients with LVH on resting electro-cardiography (n = 36). Gated SPECT measurements for left ventricular end-diastolic volume (LVEDV) index, left ventricular end-systolic volume (LVESV) index, and LVEF were obtained according to a published method, using a modified Simpson's rule technique. Results: Similar results were obtained for mean LW and LVEF measurements between normotensive patients and hypertensive patients without LVH. Hence, these groups were combined (as group 1). By contrast, hypertensive patients with LVH (group 2), had significantly lower LVEF values (P = 0.01) and higher mean LVESV index values than normotensive patients (P = 0.03). Sex differences were marked: women had significantly higher mean resting LVEF values than men (P < 0.0001) and significantly lower mean resting LVEDV index values (P < 0.0001). A significant relationship was seen between LVEDV index and LVEF (r = –0.60; P < 0.0001) and between LVEDV index and heart rate (r = –0.26; P < 0.001). The normal limits were LVEF 41% in men and 49% in women, LVEDV index 76 mL/m² in men and 57 mL/m² in women, and LVESV index 38 mL/m² in men and 26 mL/m² in women. Among hypertensive patients, 22% with LVH had an abnormally low LVEF and 19% had an increased LVEDV index according to these test criteria. By contrast, no hypertensive patients without LVH had an abnormally low LVEF, and only 6% had volume abnormalities. Conclusion: Using a cohort of low-likelihood patients, we generated sex-specific normal limits for LW and LVEF for myocardial perfusion gated SPECT. Application of these findings resulted in the detection of occult left ventricular dysfunction in approximately one fifth of hypertensive patients for whom concomitant LVH was found through resting electrocardiography. These normal limits can now be evaluated prospectively for their potential clinical value.

Key Words: normal limits • gated SPECT • left ventricular volume • ejection fraction

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