1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Additional value of systolic wall thickening in myocardial stunning evaluated by stress-rest gated perfusion SPECT
Alberto Bestetti1, B. Cuko2 , A. Decarli3 , Alessio Galli4, Federico Lombardi41 1Department of Clinical and Biomedical Sciences, University of Milan; Service of Nuclear Medicine, IRCCS Multimedica Sesto San Giovanni, Milan, Italy; 2 School of Specialty in Nuclear Medicine, University of Milan, Milan, Italy; 3 Department of Clinical and Community Sciences, University of Milan, Milan, Italy; 4 Cardiovascular Diseases Unit, IRCCS Ca' Granda Major Hospital of Milan, University of Milan, Milan, Italy.
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Professor Alberto Bestetti, M.D.
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2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1- Stress-rest gated SPECT is a valuable tool for assessing myocardial perfusion and function in ischemic patients.
2- Myocardial stunning is a phenomenon of reversible contractile dysfunction caused by coronary hypoperfusion during stress. Revascularization is generally indicated when myocardial stunning is present.
3- It is debated which is the best parameter to define myocardial stunning, whether wall thickening summed difference score (WT-SDS) or the variation in left ventricular ejection fraction with exercise (∆LVEF).
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3. METHODS Study type: retrospective.
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type: retrospective.
Study subjects: 91 ischemic patients (82 males; mean age 59.7 ± 10.3), with coronary artery disease documented by angiography. Ischemia was defined as a summed difference score ≥ 5 at stress-rest gated SPECT.
Study endpoints:
Primary end point: to evaluate the correlation between ∆LVEF and WT-SDS.
Secondary end point: to identify the best independent parameter correlated with myocardial ischemia.
Study variables:
- Perfusion: summed stress score, summed rest score, summed
difference score.
- Function: wall thickening summed stress score, wall thickening summed rest score,
wall thickening summed difference score, left ventricular ejection fraction (LVEF),
∆LVEF, end-diastolic and end systolic volumes.
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4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Figure 1A. This figure shows the good inverse linear correlation between WT-SDS and ∆LVEF (RHO=-0.33, p=0.002).
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5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Figure 1B. This figure shows a good linear correlation between SDS and WT-SDS (RHO= 0.32, p=0.002).
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6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
1- In ischemic patients post-stress left ventricular function is significantly lower than at rest (ΔLVEF -2.2 ± 4.8, p = ; WT-SDS 4.44 ± 4.13, p = ): this is the stunning phenomenon.
2- At multivariate analysis WT-SDS, and not ΔLVEF, is significantly correlated with the degree of myocardial ischemia (SDS). However, there is an inverse linear correlation between WT-SDS and ΔLVEF.
3- Patients divided according to the severity of ischemia (< 8 or ≥ 8 SDS) show significantly different values of WT-SDS, but not ΔLVEF.
4- WT-SDS should be evaluated in all patients with suspected myocardial stunning candidates to revascularization.
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