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Electrocardiographically Gated Blood-Pool SPECT and Left Ventricular Function: Comparative Value of 3 Methods for Ejection Fraction and Volume Estimation

Department of Nuclear Medicine, Bichat Hospital, Paris; Departments of Nuclear Medicine and Cardiology, Antoine Béclère Hospital, Clamart; and Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France

The current major limitation to development of electrocardiographically (ECG) gated blood-pool SPECT (GBPS) for measurement of the left ventricular (LV) ejection fraction (LVEF) and volumes is the lack of availability of clinically validated automatic processing software. Recently, 2 processing software methods for quantification of the LV function have been described. Their LVEFs have been validated separately, but no validation of the LV volume measurement has been reported. Methods: We compared 3 processing methods for evaluation of the LVEF (n = 29) and volumes (n = 58) in 29 patients: automatic geometric method (GBPS_G), semiautomatic activity method (GBPS_M), and 35% maximal activity manual method (GBPS_35%). The LVEF provided by the ECG gated equilibrium planar left anterior oblique view (planar_LAO) and the LV volumes provided by LV digital angiography (Rx) were used as gold standards. Results: Whereas the GBPS_G and GBPS_M methods present similar low percentage variabilities, the GBPS_35% method provided the lowest percentage variabilities for the LVEF and volume measurements (P < 0.04 and P < 0.02, respectively). The LVEF and volume provided by the 3 methods were highly correlated with the gold standard methods (r > 0.98 and r > 0.83, respectively). The LVEFs provided by the GBPS_35% and GBPS_M methods are similar and higher than those of the GBPS_G method and planar_LAO method, respectively (P < 0.0001). For the LVEF, there is no correlation between the average and paired absolute difference for the 3 GBPS methods against the planar_LAO method, and the limits of agreement are relatively large. LV volumes are lower when calculated with the GBPS_M, GBPS_G, and Rx methods (P < 0.0001). However, the GBPS_35% and Rx methods provide LV volumes that are similar. There is no linear correlation between the average and the paired absolute difference of volumes calculated with the GBPS_G and GBPS_35% methods against Rx LV volumes. However, a moderate linear correlation was found with the GBPS_M method (r = 0.6; P = 0.0001). The 95% limits of agreement between the Rx LV volumes and the 3 GBPS methods are relatively large. Conclusion: GBPS is a simple, highly reproducible, and accurate technique for the LVEF and volume measurement. The reported findings should be considered when comparing results of different methods (GBPS vs. planar_LAO LVEF; GBPS vs. Rx volume) and results of different GBPS processing methods.

Key Words: left ventricular ejection fraction • cardiac radionuclide angiography • gated SPECT • left ventricular volume • left ventricular function

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