Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization
Dineshkumar Patel 1,
Vincent J.B. Robinson 2*,
Roque B. Arteaga 1,
and
John W. Thornton 3
1 Section of Cardiology, Department of Medicine, Medical College of Georgia, Augusta, Georgia; Specialty Service Line, Charlie Norwood VA Medical Center, Augusta, Georgia
2 Section of Cardiology, Department of Medicine, Medical College of Georgia, Augusta, Georgia; Specialty Service Line, Charlie Norwood VA Medical Center, Augusta, Georgia; Department of Radiology, Medical College of Georgia, Augusta, Georgia
3 Section of Cardiology, Department of Medicine, Medical College of Georgia, Augusta, Georgia
* To whom correspondence should be addressed. E-mail: vrobinso{at}mcg.edu.
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Abstract |
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Morbidity and mortality increase when diastolic dysfunction accompanies coronary artery disease (CAD). An elevated stress 201Tl lung-to-heart ratio (LHR) is a traditional marker of elevated left ventricular end-diastolic pressure (LVEDP), which adds prognostic value in CAD. Since the introduction of 99mTc-labeled agents, this valuable marker has been lost. Hence, there is only a limited ability to assess diastolic dysfunction by myocardial perfusion imaging (MPI). Methods: Fifty-two consecutive patients with an ejection fraction of 
45% underwent MPI and cardiac catheterization within 15 d. Peak filling rate (PFR), time to PFR (TPFR), and filling rate during the first third of diastole (1/3FR) were obtained from MPI with SPECT software. Resting 201Tl LHR was calculated manually, and LVEDP was obtained at catheterization. Results: PFR, TPFR, and 1/3FR correlated significantly with LVEDP (r = -0.53, 0.45, and -0.45, respectively; P = 0.00005, 0.0009, and 0.0009, respectively), whereas resting 201Tl LHR did not (r = 0.10, P = 0.49). Receiver-operating-characteristic curve analysis of PFR, TPFR, and 1/3FR for detecting LVEDPs of 18 mm Hg showed areas under the curve of 0.83, 0.75, and 0.80, respectively. The combination of PFR and 1/3FR showed a negative predictive value of 84%, a positive predictive value of 86%, and a specificity of 94%. Conclusion: Diastolic filling variables obtained with the SPECT software showed a significant correlation with LVEDP. PFR, TPFR, and 1/3FR were superior to resting 201Tl LHR and showed good sensitivity, specificity, and predictive power for detecting LVEDPs of 18 mm Hg. Hence, combining data on the presence of perfusion defects with data on diastolic impairments can be achieved by adding these variables to MPI results.
Key Words:
diastole, heart failure, gated SPECT, ventricles
