Predictors of in-hospital cardiac complications in patients with Takotsubo syndrome.

Takotsubo syndrome (TTS) has been recognized as a benign condition mainly due to its reversibility. However, recent researches have demonstrated that serious cardiac complications could occur during hospitalization. Thus, the aim of this study is to detect factors associated with in-hospital cardiac complications in patients with TTS. A total of 154 consecutive patients with TTS were enrolled retrospectively. In-hospital cardiac complications were observed in 61 patients (40%), including 44 patients with pulmonary edema (29%) and 25 patients with cardiogenic shock (16%). Multivariate logistic regression analysis identified lower systolic blood pressure on admission (OR 0.97, 95% CI 0.96-0.99, p = 0.001), history of diabetes mellitus (OR 2.92, 95% CI 1.01-8.41, p = 0.04), and ß-blocker use before admission (OR 16.9, 95% CI 1.57-181.7, p = 0.006) as independent predictors of in-hospital cardiac complications, while chest pain at onset was identified as a negative predictor of cardiac complications during hospitalization (OR 0.20, 95% CI 0.07-0.55, p = 0.001). Patients with cardiac complications more often needed hemodynamic support and longer hospital stay than those without (21.2 ± 19.4 vs. 11.8 ± 16.8 days, p = 0.002). TTS should be no longer recognized as a benign disease, but requiring careful management. We should obtain vital signs and patient's medical history carefully as soon as possible after admission to predict in-hospital cardiac complications.

Combined assessment of left ventricular end-diastolic pressure and ejection fraction by left ventriculography predicts long-term outcomes of patients with ST-segment elevation myocardial infarction.

In patients with ST-segment elevation myocardial infarction (STEMI), it is unclear if combined assessment of left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF) improves prediction of major adverse cardiac events (MACE). We analyzed data from 266 STEMI patients who underwent successful percutaneous coronary intervention and subsequent left ventriculography (LVG). Patients were divided into 4 groups, as follows: Group 1, LVEDP < 21 mmHg and LVEF ≥ 55%; Group 2, LVEDP < 21 mmHg and LVEF < 55%; Group 3, LVEDP ≥ 21 mmHg and LVEF ≥ 55%; and Group 4, LVEDP ≥ 21 mmHg and LVEF < 55%. Multivariate Cox proportional hazards analysis was used to determine if LVEDP and LVEF were associated with MACE (including cardiac death, non-fatal myocardial infarction, and heart failure requiring hospitalization). Change in LV parameters was assessed in the subset of 183 patients who underwent serial LVG (mean interval 6.3 ± 1.6 months). During a mean follow-up of 43 ± 31 months, 29 patients (10.9%) had a MACE. As compared to Group 1, MACE risk was significantly higher in Group 3 [hazard ratio (HR) 3.26; 95% confidence interval (CI) 1.05-10.0] and Group 4 (HR 3.99; 95% CI 1.44-11.0), but not in Group 2 (HR 0.46, 95% CI 0.54-3.96). In sub-analyses, LV end-systolic volume index after PCI was significantly higher in Group 4 than in the other groups and remained higher during follow-up. Combined LVEDP/LVEF assessment was useful in predicting MACE after successful PCI for STEMI patients and could facilitate risk stratification, as it predicts LV remodeling.

Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison.

BACKGROUND: Advanced heart failure treated with a left ventricular assist device is associated with a higher risk of right heart failure. Many advanced heart failures patients are treated with an ICD, a relative contraindication to MRI, prior to assist device placement. Given this limitation, left and right ventricular function for patients with an ICD is calculated using radionuclide angiography utilizing planar multigated acquisition (MUGA) and first pass radionuclide angiography (FPRNA), respectively. Given the availability of MRI protocols that can accommodate patients with ICDs, we have correlated the findings of ventricular functional analysis using radionuclide angiography to cardiac MRI, the reference standard for ventricle function calculation, to directly correlate calculated ejection fractions between these modalities, and to also assess agreement between available echocardiographic and hemodynamic parameters of right ventricular function. METHODS: A retrospective review from January 2012 through May 2014 was performed to identify advanced heart failure patients who underwent both cardiac MRI and radionuclide angiography for ventricular functional analysis. Nine heart failure patients (8 men, 1 woman; mean age of 57.0 years) were identified. The average time between the cardiac MRI and radionuclide angiography exams was 38.9 days (range: 1 - 119 days). All patients undergoing cardiac MRI were scanned using an institutionally approved protocol for ICD with no device-related complications identified. A retrospective chart review of each patient for cardiomyopathy diagnosis, clinical follow-up, and echocardiogram and right heart catheterization performed during evaluation was also performed. RESULTS: The 9 patients demonstrated a mean left ventricular ejection fraction (LVEF) using cardiac MRI of 20.7% (12 - 40%). Mean LVEF using MUGA was 22.6% (12 - 49%). The mean right ventricular ejection fraction (RVEF) utilizing cardiac MRI was 28.3% (16 - 43%), and the mean RVEF calculated by FPRNA was 32.6% (9 - 56%). The mean discrepancy for LVEF between cardiac MRI and MUGA was 4.1% (0 - 9%), and correlation of calculated LVEF using cardiac MRI and MUGA demonstrated an R of 0.9. The mean discrepancy for RVEF between cardiac MRI and FPRNA was 12.0% (range: 2 - 24%) with a moderate correlation (R = 0.5). The increased discrepancies for RV analysis were statistically significant using an unpaired t-test (t = 3.19, p = 0.0061). Echocardiogram parameters of RV function, including TAPSE and FAC, were for available for all 9 patients and agreement with cardiac MRI demonstrated a kappa statistic for TAPSE of 0.39 (95% CI of 0.06 - 0.72) and for FAC of 0.64 (95% of 0.21 - 1.00). CONCLUSION: Heart failure patients are increasingly requiring left ventricular assist device placement; however, definitive evaluation of biventricular function is required due to the increased mortality rate associated with right heart failure after assist device placement. Our results suggest that FPRNA only has a moderate correlation with reference standard RVEFs calculated using cardiac MRI, which was similar to calculated agreements between cardiac MRI and echocardiographic parameters of right ventricular function. Given the need for identification of patients at risk for right heart failure, further studies are warranted to determine a more accurate estimate of RVEF for heart failure patients during pre-operative ventricular assist device planning.

Voltage combined with pace mapping is simple and effective for ablation of noninducible premature ventricular contractions originating from the right ventricular outflow tract.

BACKGROUND: Premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) can resist conventional mapping strategies. Studies regarding optimal mapping and ablation methods for patients with noninducible RVOT-PVCs are limited. We retrospectively evaluated the efficacy and safety of a novel mapping strategy for these cases: voltage mapping combined with pace mapping. HYPOTHESIS: METHODS: We retrospectively included symptomatic patients (n = 148; 76 males; age, 44.5 ± 1.4 years) with drug-refractory PVCs originating from the RVOT, who underwent radiofrequency catheter ablation (RFCA), and stratified them as Group 1 and Group 2. Group 1 patients had noninducible RVOT-PVCs, determined after programmed stimulation, burst pacing, and isoproterenol infusion (n = 21; 12 males; age, 39.5 ± 10.8 years). Group 2 patients had inducible PVCs. Group 1 patients were subjected to voltage mapping combined with pace mapping; Group 2 underwent conventional mapping. In all patients prior to RFCA, detailed 3-dimensional electroanatomic voltage maps of the RVOT were obtained during sinus rhythm using the CARTO system. RESULTS: Patients from both groups had similar success and complication rates associated with the RFCA. In Group 2, 89% (113/127) experienced the earliest and the successful ablation points in the voltage transitional zone. During the follow-up (36 ± 8 months), patients from both groups suffered similar rates of PVC relapse (2/21 and 7/127, respectively; P = 0.826). CONCLUSIONS: Voltage mapping combined with pace mapping is effective and safe for patients with noninducible RVOT-PVCs determined by conventional methods.

Absence of post-extrasystolic potentiation in takotsubo cardiomyopathy: Another piece of the puzzle?

BACKGROUND: Takotsubo cardiomyopathy (TCM) is an intriguing phenomenon characterized by transient and reversible left ventricular (LV) dysfunction despite angiographically unobstructed coronary arteries. The detailed pathophysiology of stunned, viable myocardium in TCM remains to be determined. Post-extrasystolic potentiation (PESP), the phenomenon of enhanced LV contractility following extrasystole, has been used to assess myocardial viability. METHODS: Utilizing a local database, we identified 74 cases that met the modified Mayo Clinic criteria for TCM between October 2004 and March 2016. The patients undergoing left ventriculography were assessed for the presence of fortuitously provoked extrasystoles and the presence or absence of PESP. RESULTS: The baseline characteristics of TCM were 93.2% female patients with median age of 69 and majority cases were apical type (77%). In-hospital mortality was observed in 3 cases (4.1%), all of which were apical type. We observed improved ejection fraction after extrasystole compared to baseline, however stunned myocardium had minimal PESP whereas unaffected myocardium showed marked potentiation. CONCLUSION: Extrasystoles in TCM failed to elicit PESP in affected LV segments despite viability in those segments, in turn implicating a calcium handling abnormality in TCM. Potential explanations of our results may be that catecholamine excess caused maximum calcium release so that an extrasystole could not enhance contractility any further, or that there is a regional insensitivity to calcium release due to a disturbance of the calcium regulatory system at the molecular level despite the bolus of calcium availability provided by the extrasystole.

A case of contrast-induced pancreatitis following cardiac catheterization.

Coronary heart disease remains the leading cause of death of men and women in the United States. Angiography and percutaneous coronary interventions (PCI) are an integral part in management of acute coronary syndromes. Well-defined complications of coronary angiography include allergic and anaphylactic reactions, vascular access complications, stroke, and contrast-induced kidney injury. Radiographic contrast agents (RCAs) are known to cause acute kidney injury. RCAs are also postulated to induce pancreatitis in experimental animal models. We present a patient with acute pancreatitis immediately following coronary angiography. Recent studies have described that the use of RCA is associated with worse prognosis in patients with ongoing pancreatitis. The pathophysiology of RCA-induced pancreatitis is poorly understood. Although extremely rare, RCA-induced pancreatitis should be considered in the appropriate clinical setting.

Reproducibility of first-pass cardiovascular magnetic resonance myocardial perfusion.

PURPOSE: To assess the reproducibility of semiquantitative and quantitative analysis of first-pass myocardial perfusion cardiovascular magnetic resonance (CMR) in healthy volunteers. MATERIALS AND METHODS: Eleven volunteers underwent myocardial perfusion CMR during adenosine stress and rest on 2 separate days. Perfusion data were acquired in a single mid-ventricular section in two cardiac phases to permit cardiac phase reproducibility comparisons. Semiquantitative analysis was performed to derive normalized upslopes of myocardial signal intensity profiles (myocardial perfusion index, MPI). The quantitative analysis estimated absolute myocardial blood flow (MBF) using Fermi-constrained deconvolution. The perfusion reserve index was calculated by dividing stress by rest data. Two observers performed all the measurements independently. One observer repeated all first scan measurements 4 weeks later. RESULTS: The reproducibility of perfusion CMR was highest for semiquantitative analysis with an intraobserver coefficient of variability (CoV) of 3%-7% and interobserver CoV of 4%-10%. Semiquantitative interstudy comparison was less reproducible (CoV of 13%-27%). Quantitative intraobserver CoV of 10%-18%, interobserver CoV of 8%-15% and interstudy CoV of 20%-41%. Reproducibility of systolic and diastolic phases and the endocardial and epicardial myocardial layer showed similar reproducibility on both semiquantitative and quantitative analysis. CONCLUSION: The reproducibility of CMR myocardial perfusion estimates is good, but varies between intraobserver, interobserver, and interstudy comparisons. In this study semiquantitative analysis was more reproducible than quantitative analysis.

[Assessment of the functional state of the right ventricle by radionuclide tomoventriculography].

The aim of this work was to evaluate the potential of radionuclide tomoventriculography (RTVG) for the study of the functional state of right ventricle (RV) in patients with thromboembolism of branches of the pulmonary artery (TEPA) or ventricular arrhythmias. A total of 96 patients were admitted for examination to the clinics of Research Institute of Cardiology, Siberian Division of Russian Academy of Medical Sciences in 2006-2008. They were divided into 3 groups. Group 1 (n = 40) included patients of mean age 62 +/- 11 years with non-massive TEPA, group 2 (n = 15) patients with coronary heart disease NYHA class I-II (50 +/- 9 years), group 3 (n = 4) children and adolescents 13.2 +/- 3.7 years with ventricular extrasystole and/or monomorphic ventricular tachycardia. All patients were examined by ECG-synchronized RTVG. The study showed that this method can be used to efficaciously determine volume characteristics of right ventricle, ejection fraction, relationship between fast and slow filling phases, and intreventricular dyssynchronism. The functional ability of the right side of the heart in patients with minor lesions in the pulmonary vasculature should be regarded as a sign of acute thromboembolism and marked systole-diastolic dysfunction of right ventricle (under similar conditions) as a manifestation of chronic post-thromboembolic hypertension. The number of areas of asynchronous myocardial contractions and the degree of intraventricular dyssynchronism detected by RTVG positively correlate with the degree of contractile dysfunction of right ventricle. Scintiographic signs of intraventricular dyssynchronism suggest predominance of contractile heterogeneity of right ventricle over physiological one.

Enfermedad de Tako-Tsubo / The Tako-Tsubo disease

La enfermedad de “Tako-Tsubo”, conocida también como miocardiopatía de Tako-Tsubo o miocardiopatía por estrés, está caracterizada por dolor torácico, anormalidades del segmento ST-onda T en el ecosonograma, niveles séricos elevados de enzimas cardíacas y alteraciones en la motilidad del VI consistentes en acinesia apical extensa de carácter reversible. Describir las características clínicas y la experiencia del Centro Cardiovascular La Floresta en pacientes con miocardiopatía de Tako-Tsubo. Se realizó el diagnóstico de miocardiopatía de Tako-Tsubo en función de los criterios mayores y menores a pacientes ingresados a la sala de emergencia en el contexto de síndrome coronario agudo, sometidos a evaluación angiográfica, ecocardiográfica y egresados con seguimiento clínico y ecocardiográfico entre enero de 2006 a enero de 2008. De 288 pacientes 14 (5 %) cumplieron con criterios diagnósticos para miocardiopatía de Tako-Tsubo, todos refirieron estrés psicológico como desencadenante, cinco de estos 14 pacientes (36%), padecían de neoplasias malignas bajo tratamiento con quimioterapia, con edades promedio de 62 ± 12 años, de los cuales 9 (64%) fueron mujeres, todos con elevación de marcadores enzimáticos. Al ecosonograma presentaron alteraciones. En el ecocardiograma los pacientes tuvieron evidencia de acinesia apical y la fracción de eyección que estuvo por encima del límite inferior. Todos fueron sometidosa angiografía coronaria convencional y ventriculografía. La miocardiopatía de Tako-Tsubo es una entidad bien definida que imita a un síndrome coronario agudo. La estrategia diagnóstica está basada en la angiografía coronaria precoz sin omitir la ventriculografía. Especial interés debe ser puesto en pacientes con enfermedades neoplásicas que reciban quimioterapia.

Tako-Tsubo” disease, also known as apical ballooning of the left ventricle or stress cardiomyopathy, is characterized by resting chest pain, ST-T changes on the ECG, elevated cardiac biomarkers and reversible extensive apical akinesis which mimics, at end systole, a japanese jar used to trap octopodes called “Tako-Tsubo”. To describe our experience at the “Instituto Médico La Floresta” in patients with Tako-Tsubo disease. The diagnosis of Tako-Tsubo disease was made based on major and minor criteria to patients admitted to the emergency department with the diagnosis of acute coronary syndrome, between january 2006 and january 2008. All patients underwent cardiac catheterization, coronary angiography, left ventriculography and transthoracic echocardiography and were followed-up clinically and with echocardiography for 6 months. Of 288 patients, 14 (5%) met the criteria for Tako-Tsubo disease, all had emotional stress as a trigger, 5 of these 14 pts (36%) had malignancies on chemotherapy. The age range was 62±12 years, 9 patients (64%) were women, all with elevated CK and CK-MB and 7 (50%) had also increased troponin levels. On the ECG 11 patients (79%) had inverted T waves and 3 (21%) showed ST segment elevation. One patient (7%) developed non-sustained ventricular tachycardia. On the echocardiogram and left ventriculography all showed the typical pattern of Tako-Tsubo disease at end systole and none had neither evidence of left ventricular outflow tract obstruction nor coronary artery disease. Tako-Tsubo disease is a distinct entity which mimics an ACS. The suggested approach is an early diagnostic coronary angiography with left ventriculography. Patients with malignancies on chemotherapy deserve special attention.

Fully automated motion correction in first-pass myocardial perfusion MR image sequences.

This paper presents a novel method for registration of cardiac perfusion magnetic resonance imaging (MRI). The presented method is capable of automatically registering perfusion data, using independent component analysis (ICA) to extract physiologically relevant features together with their time-intensity behavior. A time-varying reference image mimicking intensity changes in the data of interest is computed based on the results of that ICA. This reference image is used in a two-pass registration framework. Qualitative and quantitative validation of the method is carried out using 46 clinical quality, short-axis, perfusion MR datasets comprising 100 images each. Despite varying image quality and motion patterns in the evaluation set, validation of the method showed a reduction of the average right ventricle (LV) motion from 1.26+/-0.87 to 0.64+/-0.46 pixels. Time-intensity curves are also improved after registration with an average error reduced from 2.65+/-7.89% to 0.87+/-3.88% between registered data and manual gold standard. Comparison of clinically relevant parameters computed using registered data and the manual gold standard show a good agreement. Additional tests with a simulated free-breathing protocol showed robustness against considerable deviations from a standard breathing protocol. We conclude that this fully automatic ICA-based method shows an accuracy, a robustness and a computation speed adequate for use in a clinical environment.

Myocardial performance index correlates with right ventricular ejection fraction measured by nuclear ventriculography.

BACKGROUND: Assessment of right ventricular (RV) ejection fraction (EF) by two-dimensional echocardiography (2D ECHO) is practical but limited because of complex geometry of the RV. Techniques used for accurate measurement of RV EF are invasive or costly. However, derivation of 2D ECHO Doppler parameters to estimate RV function could be useful and inexpensive. METHODS: RV EF measured by nuclear ventriculography was compared with 2D ECHO estimates of myocardial performance index (MPI) and peak tricuspid annular systolic velocity (PTASV). Linear regression analysis and sensitivity analysis were used to analyze the data. RESULTS: RV EF measured by nuclear ventriculography correlated with MPI significantly (r =-0.55, P = 0.005) but not with PTASV (r = 0.09, P = 0.69). Using abnormal RV EF <45% measured by nuclear ventriculography, the sensitivity and specificity for MPI > 0.50 were 45.4% and 100%, respectively. The sensitivity and specificity of PTASV < or = 17.25 cm/sec in detecting abnormal RV EF were 100% and 35.4%. CONCLUSION: MPI greater than 0.50 indicates that RV function is abnormal and a value of PTASV > 17.25 cm/sec indicates normal RV function.

Cardiac rupture or pericardial effusion?

After cardiogenic shock, myocardial rupture is the leading cause of in-hospital death from acute myocardial infarction (AMI). When possible, rapid diagnosis must lead to an emergency surgical repair to prevent sudden death. However, in some cases, despite new imaging techniques, the diagnosis may be difficult to obtain and the decision whether or not to operate, difficult. In the present report we describe the challenging case of a patient presenting a sub-acute cardiac rupture three days after anterior AMI.

Comparison of gated blood pool SPECT and spiral multidetector computed tomography in the assessment of right ventricular functional parameters: validation with first-pass radionuclide angiography.

OBJECTIVE: The aim of this study was to compare gated blood pool single photon emission computed tomography (SPECT) (GBPS) and multidetector row computed tomography (MDCT) for the determination of right ventricular ejection fraction (RVEF) and right ventricular volumes (RVV) and to compare first-pass radionuclide angiography (FP-RNA) as the gold standard. METHODS: Twenty consecutive patients (11 men, 9 women) referred for MDCT for the evaluation of the presence of coronary artery disease underwent FP-RNA and GBPS. RESULTS: The mean right ventricular end-diastolic volume (EDV) calculated with GBPS revealed a statistically significant lower value than that of MDCT. The mean right ventricular end-systolic volume (ESV) calculated with GBPS was also lower than that of MDCT. A comparison of right ventricular EDV from GBPS and MDCT yielded a correlation coefficient of 0.5972. Right ventricular ESV between GBPS and MDCT showed a correlation coefficient of 0.5650. The mean RVEFs calculated with FP-RNA (39.8% +/- 4.0%), GBPS (43.7% +/-6.9%0), and MDCT (40.4% + 7.7%) showed no statistical differences (Kruskal-Wallis statistics 4.538, P = 0.1034). A comparison of RVEFs from FP-RNA and GBPS yielded a correlation coefficient of 0.7251; RVEFs between FP-RNA and MDCT showed a correlation coefficient of 0.6166 and between GBPS and MDCT showed a correlation coefficient of 0.6367. CONCLUSION: The RVEF, EDV, and ESV calculated by GBPS had good correlation with those obtained with MDCT. In addition, there were no statistical differences of RVEF calculated from FP-RNA, GBPS, and MDCT. However, with regard to RVV, EDV and ESV from GBPS revealed statistically significantly lower values than those of MDCT. Although reasonable correlations among these modalities were obtained, the agreement among these three modalities was not good enough for interchangeable use in the clinical setting. Also, these results should be confirmed in patients with cardiac diseases in future larger population-based studies.

High-resolution myocardial perfusion imaging at 3 T: comparison to 1.5 T in healthy volunteers.

The purpose of this study was to evaluate high-resolution (HR) myocardial first-pass perfusion in healthy volunteers at 3 T compared to a typical clinical imaging protocol at 1.5 T, with respect to overall image quality and the presence of subendocardial dark rim artifacts. Myocardial first-pass rest perfusion studies were performed at both field strengths using a T1-weighted saturation-recovery segmented k-space gradient-echo sequence combined with parallel imaging (Gd-DTPA 0.05 mmol/kg). Twenty-six healthy volunteers underwent (1) a HR perfusion scan at 3 T(pixel size 3.78 mm(2)) and (2) a standard perfusion approach at 1.5 T(pixel size 9.86 mm(2)). The contrast enhancement ratio (CER) and overall image quality (4-point grading scale: 4: excellent; 1: non-diagnostic) were assessed, and a semiquantitative analysis of dark rim artifacts was performed for all studies. CER was slightly higher (1.31 +/- 0.32 vs. 1.14 +/- 0.34; p<0.01), overall image quality was significantly improved (3.03 +/- 0.43 vs. 2.37 +/- 0.39; p<0.01), and the number of dark rim artifacts (139 +/- 2.09 vs. 243 +/- 2.33; p<0.01) was significantly reduced for HR perfusion imaging at 3 T compared to the standard approach at 1.5 T. HR myocardial rest perfusion at 3 T is superior to the typical clinical perfusion protocol performed at 1.5 T with respect to the overall image quality and presence of subendocardial dark rim artifacts.

Right-sided cardiac function in healthy volunteers measured by first-pass radionuclide ventriculography and gated blood-pool SPECT: comparison with cine MRI.

BACKGROUND: Right ventricular (RV) function is of interest in an array of cardiopulmonary diseases. First-pass radionuclide ventriculography (FP), gated blood-pool single photon emission tomography (GBPS) and cardiac magnetic resonance imaging (MRI) are three currently used non-invasive methods for evaluation of right-sided cardiac function. The aim of our study was to compare the agreement between these methods when measuring right-sided cardiac function. METHODS: Twenty-four healthy volunteers were included. Mean age was 44 years (range: 25-60) and 29% were females. All participants had FP, GBPS and breath-hold cine MRI performed according to standard protocols. RESULTS: Normal ranges for RV ejection fraction (RVEF) defined as mean +/- 2SD were 0.49-0.72, 0.44-0.66 and 0.40-0.69 when measured by MRI, FP and GBPS respectively. Bland-Altman analysis showed a mean difference (bias) between MRI and FP of 0.05 (95% CI: 0.03-0.08) and of 0.06 (95% CI: 0.02-0.10) between MRI and GBPS. No systematic bias was found between FP and GBPS. Normal values for RV end-diastolic volume index (RVEDVI) were 37-95 and 29-91 ml m(-2) when measured by MRI and GBPS respectively. The mean difference between RVEDVI was 6 ml m(-2) (95% CI: 0-11). CONCLUSIONS: (i) Normal values of RVEF differ between MRI, FP and GBPS with wide limits of agreement, accordingly it is difficult to evaluate changes over time if measured by different methods, (ii) RV volumes are in the same range when measured by MRI or GBPS but with wide limits of agreement, and (iii) if MRI is considered gold standard then FP is more accurate than GBPS for RVEF measurements.

Automatic quantification of right ventricular volumes and right ventricular ejection fraction with gated blood pool SPECT: Comparison of 8- and 16-frame gated blood pool SPECT with first-pass radionuclide angiography.

BACKGROUND: The aim of this study was to compare 8- and 16-frame gated blood pool single photon emission computed tomography (SPECT) (GBPS) for the determination of right ventricular ejection fraction (RVEF) and right ventricular (RV) volumes in subjects who underwent two consecutive GBPS studies. METHODS AND RESULTS: In this study 65 consecutive patients (29 men and 36 women) referred for first-pass radionuclide angiography (FP-RNA) underwent FP-RNA and both 8- and 16-frame GBPS. The mean FP-RNA RVEF was statistically lower than RVEF determined by 8-frame GBPS (P < .001) and 16-frame GBPS (P < .001). Comparison of RVEF by FP-RNA and GBPS yielded coefficients of 0.8666 (P < .0001) for 16-frame GBPS and 0.7290 (P < .0001) for 8-frame GBPS. The correlation of RVEF between 8- and 16-frame GBPS showed a coefficient of 0.6657 (P < .0001). The mean RV end-diastolic volume (EDV) calculated with 8- and 16-frame GBPS showed no statistical differences (P = .3580). The mean RV end-systolic volume (ESV) calculated with 8- and 16-frame GBPS also showed no statistical differences (P = .2265). Comparison of EDV by 8- and 16-frame GBPS yielded a coefficient of 0.7327 (P < .0001). The correlation between ESV by 8-frame GBPS and 16-frame GBPS showed a coefficient of 0.6067 (P < .0001). CONCLUSION: GBPS is a simple and reproducible acquisition method for the assessment of RVEF and RV volumes. RVEF values calculated by 8- and 16-frame GBPS correlated well with FP-RNA, although mean RVEF values from FP-RNA were lower than GBPS RVEF values. In addition, RV ESV and EDV were both well correlated with 8- and 16-frame GBPS. GBPS should prove to be useful in diagnosis, as well as in following disease progression and evaluating the efficacy of therapeutic interventions, in patients with biventricular dysfunction.