HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wheat, J. M. Articles by Currie, G. M. Search for Related Content PubMed PubMed Citation Articles by Wheat, J. M. Articles by Currie, G. M.

Rest Versus Stress Ejection Fraction on Gated Myocardial Perfusion SPECT

School of Clinical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia

Objectives: It is widely accepted that exercise-induced stunning has an impact on left ventricular ejection fraction (EF); yet, despite the recommendations of the American Society of Nuclear Cardiology, many departments only perform gated SPECT on stress studies. The aim of this investigation was to determine the relationship between rest EF and stress EF in myocardial perfusion studies and to identify possible predictors of variability.

Methods: This study was a retrospective cross-sectional study of 133 patients (266 studies) undergoing myocardial perfusion SPECT. Automated computer-generated functional data (end-diastolic volume, end-systolic volume [ESV], and EF) for rest and stress studies were correlated as matched pairs and analyzed with respect to the following variables: age, sex, stress method, time between stress and scanning, and presence or absence of pathology scintigraphically. Differences in matched EF pairs (EF) and transient dilatation were also determined.

Results: Matched pairs of rest EF and stress EF demonstrated excellent correlation (0.90) with no significant difference noted (P = 0.15). Bland–Altman analysis demonstrated a mean EF of –0.65% (95% confidence interval [CI], –1.54% to 0.23%) with 94% of data points within the 95% limits of agreement. No statistically significant difference was determined between the mean EF and the hypothetic mean of 0 (P = 0.15). A time between stress and scanning of <45 min was shown to be predictive of a negative EF (P = 0.04). Transient dilatation was shown to be predictive of a negative EF (P = 0.01). Resting ESVs between 25 and 50 mL were shown to be predictive of a negative EF (P = 0.02). A stress EF of <50% was also shown to be predictive of a negative EF (P = 0.003).

Conclusion: No statistically significant difference between stress and rest EF was demonstrated and no trend was identified toward either under- or overestimation of the stress EF with a EF. A negative EF was, however, predicted by transient dilatation of >1.0, a time between stress and scanning of <45 min, a stress EF of <50, and an ESV between 25 and 50 mL. Gated SPECT performed on both stress and rest studies may provide a mechanism to predict exercise-induced stunning and transient dilatation.

Key Words: ejection fraction; rest versus stress; myocardial perfusion; gated SPECT; exercise-induced stunning; transient dilatation