Department of Nuclear Medicine Asan Medical Center, Seoul, Korea The correlation analysis of Stress / Rest Ejection Fraction of 201Tl gated myocardial perfusion SPECT Department of Nuclear Medicine Asan Medical Center, Seoul, Korea Dong Seok Kim

Contents Introduction Purpose Materials and Method Results Conclusion 1 Purpose 2 Materials and Method 3 Results 4 Conclusion 5

Introduction Gated myocardial perfusion SPECT Important diagnostic and prognostic information - ventricular wall motion - thickening information Achieve additional information from patients without additional scan

Possibility of stress induced Introduction Inacurracy of heart function - underestimation of heart volume - overestimation of Ejection fraction Possibility of stress induced myocardial stunning The problem of gated SPECT

Purpose 1 2 3 Insufficiency of investigation of 201Tl Gated SPECT Determination of Stress/Rest data correlation 1 Insufficiency of investigation of 201Tl Gated SPECT 2 Determination of EF variation predictors

Materials and method Term Object Equipment Feb. 2008 ~ Feb. 2009 Nuclear Medicine of ASAN Medical Center Object 144 patients with Tl-201 myocardial perfusion SPECT Equipment INFINIA(GE)

Materials and method 1. Radionuclide : 201Tl 3mCi 2. Collimator : LEGP 3. 201Tl Gamma Spectrum : 70keV, 167keV photo peak 15%,10% window level 4. Acquisition time : per 6° 50sec

Materials and method EDV 70ml[8] ESV 35ml[4] EF 55%

Stress functional data Analysis The comparison of Stress/Rest functional data Stress functional data Rest functional data Text Matched Paired t-test Bland-Altman analysis

Stress/Rest matched pairs (p) Results Functional data of Stress and Rest studies EF(%) EDV(mL) ESV(mL) Stress mean 60.9 (59.2-62.7) 79.2 (74.4-83.9) 33 (29.6-36.4) Rest mean 61.5 (59.8-63.2) 71.4 (66.8-75.9) 29.6 (26.4-32.8) Stress/Rest matched pairs (p) 0.11 <0.01 Values in parentheses represent 95% CI

Results The comparison of Stress/Rest functional data EF (r= 0.92) EDV (r= 0.95) ESV (r= 0.96)

Results Bland-Altman analysis of mean of stress/rest matched pairs versus ΔEF There was no statistically significant difference(p=0.10)

Reversible perfusion defect Results Independent predictors of statistically ΔEF difference Mean ΔEF(%) P value Stress EF < 55% -2.02 0.01 Rest ESV < 28mL -0.96 0.04 Reversible perfusion defect -2.16

Phamarcologic method - Only use adenosine Limitation 1 Disregard of other factor Arrythmia exam time interval ` 2 Phamarcologic method - Only use adenosine

Conclusion 1 2 Like 99mTc-MIBI studies, there was no statistically significant difference mostly. The clinical application of predictors of EF variability. - useful to expect statistically significant EF variation.

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