sodium-pertechnetate-tc-99m and Ventricular-Dysfunction--Left

Repeated left ventricular ejection fraction (LVEF) analyses with sequential single-dose radionuclide ventriculography might be an interesting technique for monitoring the effect of positive inotropic interventions. The aim of the study was to assess the reproducibility of LVEF measurement with planar radionuclide ventriculography within 3 h, using a standard single dose of radioactive tracer.. Sixteen patients underwent routine planar radionuclide ventriculography with a standard dose of 500 MBq of [Tc]pertechnetate and returned after 3 h for a repeat planar radionuclide ventriculography without administration of additional tracer.. The average initial LVEF was 35.1+/-18.6%-point (range, 12%-point to 68%-point). The mean difference of the LVEF between the initial planar radionuclide ventriculography and the repeat planar radionuclide ventriculography was 2.8%+/-6.3% (range, -11.8% to 13.3%, P=NS). The correlation between both measurements was significant with a correlation coefficient of 0.995 (P<0.01). Bland-Altman analysis revealed a mean LVEF difference of 0.94%-point between the baseline planar radionuclide ventriculography and the repeat planar radionuclide ventriculography (95% confidence interval: -2.7%-point to 4.5%-point). The visual wall motion assessment showed excellent reproducibility, with a kappa-statistic of 0.98.. Repeated radionuclide ventriculography with a 3 h interval using a single standard dose of 500 MBq of [Tc]pertechnetate is highly reproducible and will be useful for monitoring the effect of positive inotropic interventions.

Topics: Feasibility Studies; Female; Humans; Image Interpretation, Computer-Assisted; Injections, Intravenous; Male; Middle Aged; Radionuclide Ventriculography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Dysfunction, Left

Topics: Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Gated Blood-Pool Imaging; Humans; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Dysfunction, Left

Planar equilibrium radionuclide angiocardiography (ERNA) has been used as the gold standard for assessment of left ventricular (LV) function for over three decades. However, this imaging modality has recently gained less favor due to growing concerns about radiation exposure. We developed a novel approach that involves integrating short axis slices of gated bloodpool SPECT for quantification of LV function with improved signal-to-noise ratio and reduced radioactive dose while maintaining image quality and quantitative precision.. Twenty patients referred for ERNA underwent standard in vitro. The Yale method resulted in the most consistent assessment of LV function compared with the gold standard high-dose ERNA method, along with excellent inter-observer reproducibility.. The new low-dose

Topics: Aged; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Coronary Angiography; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Dysfunction, Left

Little is known about the comparison of multiple-gated acquisition (MUGA) scanning with cardiovascular magnetic resonance (CMR) for serial monitoring of HER2+ breast cancer patients receiving trastuzumab. The association of cardiac biomarkers with CMR left ventricular (LV) function and volume is also not well studied. Our objectives were to compare CMR and MUGA for left ventricular ejection fraction (LVEF) assessment, and to examine the association between changes in brain natriuretic peptide (NT-BNP) and troponin-I and changes in CMR LV function and volume. This prospective longitudinal two-centre cohort study recruited HER2+ breast cancer patients between January 2010 and December 2013. MUGA, CMR, NT-BNP and troponin-I were performed at baseline, 6, 12, and 18 months after trastuzumab initiation. In total, 41 patients (age 51.7 ± 10.8 years) were enrolled. LVEF comparison between MUGA and CMR demonstrated weak agreement (Lin's correlation coefficient r = 0.46, baseline; r = 0.29, 6 months; r = 0.42, 12 months; r = 0.39, 18 months; all p < 0.05). Bland-Altman plots demonstrated wide LVEF agreement limits (pooled agreement limits 3.0 ± 6.2). Both modalities demonstrated significant LVEF decline at 6 and 12 months from baseline, concomitant with increased LV volumes on CMR. Changes in NT-BNP correlated with changes in LV diastolic volume at 12 and 18 months (p < 0.05), and LV systolic volume at 18 months (p < 0.05). Changes in troponin-I did not correlate with changes in LV function or volume at any timepoint. In conclusion, CMR and MUGA LVEF are not interchangeable, warranting selection and utility of one modality for serial monitoring. CMR is useful due to less radiation exposure and accuracy of LV volume measurements. Changes in NT-BNP correlated with changes in LV volumes.

Topics: Adult; Antineoplastic Agents, Immunological; Biomarkers; Breast Neoplasms; Cardiac-Gated Imaging Techniques; Cardiotoxicity; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Risk Factors; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors; Tomography, Emission-Computed; Trastuzumab; Treatment Outcome; Troponin I; Ventricular Dysfunction, Left; Ventricular Function, Left

Gated blood pool SPECT (GBPS) is an alternative to planar radionuclide ventriculography (PRNV) and offers potential advantages. The aim of this study was to compare GBPS, multi-row detector spiral computed tomography (MDCT), and PRNV for the determination of left ventricular ejection fraction (LVEF) and left ventricular volumes (LV) in subjects with atypical chest pain.. Twenty-three consecutive patients (14 men, 9 women; mean age 56.2 +/- 9.5 years) referred for MDCT for evaluation of atypical chest pain. All patients underwent PRNV, GBPS, and MDCT at the same day.. The mean LVEFs calculated with PRNA (57.3 +/- 8.6%), GBPS (55.2 +/- 6.6%), and MDCT (56 +/- 9.1%) were not statistically different (F value 0.3374, p = 0.715). Comparison of LVEFs from GBPS and MDCT yielded correlation coefficients of 0.5238 (p = 0.0178, 95% CI = 0.1057-0.7845). The correlation of LVEFs between GBPS and PRNV showed a correlation coefficient of 0.8073 (p < 0.0001, 95% CI = 0.5676-0.9209) and 0.6190 (p = 0.0036, 95% CI = 0.2431-0.8333) between MDCT and PRNV. The mean LV end-diastolic volume (EDV) calculated with GBPS (82.7 +/- 17.5 ml) was significantly lower than MDCT (106.8 +/- 18.5 ml) (p = 0.0001). The mean LV end-systolic volume (ESV) calculated with GBPS (37.2 +/- 9.6 ml) was also significantly lower than MDCT (48.1 +/- 15.8 ml) (p = 0.012). Comparison of EDV from GBPS and MDCT yielded a correlation coefficient of 0.5220 (p = 0.0182, 95% CI = 0.1033-0.7835). The correlation of ESV between GBPS and MDCT showed a correlation coefficient of 0.6642 (p = 0.0014, 95% CI = 0.3140-0.8553).. In conclusion, the LVEF, EDV, and ESV calculated by GBPS correlated significantly with those of obtained with 16-MDCT. In addition, there were no statistical differences of LVEF calculated from PRNV, GBPS, and MDCT. However, with regard to LV, EDV and ESV from GBPS revealed statistically significantly lower than those of MDCT. Also, these results should be addressed whether similar results could also be found in patients with cardiac diseases by the consequent larger population-based study.

Topics: Algorithms; Chest Pain; Female; Gated Blood-Pool Imaging; Humans; Linear Models; Male; Middle Aged; Radionuclide Ventriculography; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ventricular Dysfunction, Left

Topics: Gated Blood-Pool Imaging; Humans; Quality Assurance, Health Care; Radionuclide Angiography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; United States; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right

The purpose of this study was to determine whether restrictive left ventricular (LV) filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure.. We recently demonstrated a diastolic ventricular interaction in approximately 50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despite reductions in right ventricular end-diastolic volume during volume unloading achieved by lower body negative pressure (LBNP). We reasoned that such an interaction would impede LV filling in mid and late diastole, but would be minimal in early diastole, resulting in a restrictive LV filling pattern.. Transmitral flow was assessed using pulsed wave Doppler echocardiography in 30 patients with chronic heart failure and an LV ejection fraction < or = 35%. Peak early (E) and atrial (A) filling velocities and E wave deceleration time were measured. Left ventricular end-diastolic volume was measured using radionuclide ventriculography before and during -30-mm Hg LBNP.. Nine of the 11 patients with and 2 of the 16 patients without restrictive LV filling patterns (E/A > 2 or E/A 1 to 2 and E wave deceleration time < or = 140 ms) increased LV end-diastolic volume during LBNP (p = 0.001). The change in LV end-diastolic volume during LBNP was correlated with the baseline A wave velocity (r = -0.52, p = 0.005) and E/A ratio (r = 0.50, p = 0.01).. Restrictive LV filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. Volume unloading in the setting of diastolic ventricular interaction allows for increased LV filling. Identifying patients with chronic heart failure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy.

Topics: Atrial Function, Left; Atrial Function, Right; Blood Flow Velocity; Blood Pressure; Cardiac Output; Cardiac Volume; Diastole; Echocardiography, Doppler, Pulsed; Female; Forecasting; Gated Blood-Pool Imaging; Heart Failure; Humans; Lower Body Negative Pressure; Male; Middle Aged; Mitral Valve; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Stroke Volume; Vasodilator Agents; Ventricular Dysfunction, Left; Ventricular Function, Right; Ventricular Pressure

Measurement of global left ventricular function is important in the follow-up of cardiac patients and is a good prognostic indicator in acute cardiac situations. We compared quantitative measurements of global left ventricular function made with radionuclide angiography (RNA) and contrast cardiac ventriculography (CVG) to visual semiquantitative estimates from two-dimensional echocardiographic images (2D-echo). Three hundred and thirty-nine consecutive patients who underwent RNA were assessed with 2D-echo within 3 months. In addition, 92 of these patients also underwent CVG (correlation of ejection fraction between CVG and RNA: r=0.82; P<0.0001). The RNA mean ejection fractions in the four 2D-echo groups (0=normal, 1=slightly, 2=moderate, or 3=severe reduced left ventricular function) differed markedly (P<0.0001); however, there was overlapping among the groups (2D-echo score/RNA ejection fraction: 0=57.3%+/-12.8%; 1=46.0%+/-12.9%; 2=29.6%+/- 12.2%; and 3=24.6%+/-11. 5%) and the difference between 2D-echo scores 2 and 3 was not significant. 2D-echo showed a good concordance in RNA classes (0=>/=505; 1=35%-49%; 2=21%-34%; and 3=

Topics: Cardiac Catheterization; Echocardiography; Erythrocytes; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left

To test the feasibility of rest first-pass radionuclide angiocardiography (FPRNA) using a 370-MBq (10-mCi) bolus and a single-crystal gamma camera, 40 patients underwent both FPRNA and equilibrium radionuclide angiocardiography (ERNA). Ejection fraction (EF) and regional wall motion (RWM) were assessed by three observers. The interobserver reproducibility was good: the intraclass correlation coefficient was 0.97 for both techniques. The correlation coefficient between FPRNA and ERNA EFs ranged between 0.90 and 0.92. FPRN EFs were significantly higher (P < 0.003) by less than 5 percentage points, this difference having no clinical implications for patient classification. The study provides arguments as to why this difference may be explained self-attenuation rather than counts statistics problems. Both techniques were concordant for RWM analysis. We conclude that FPRNA with 10 mCi is a reliable tool to assess rest left ventricular function, which makes it possible to perform simultaneously myocardial perfusion and function assessment in a single-day protocol using a single-crystal gamma camera.

Topics: Feasibility Studies; Gamma Cameras; Gated Blood-Pool Imaging; Heart; Humans; Observer Variation; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium Tc 99m Sestamibi; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventriculography, First-Pass

Twenty-eight children ranging in age from 1-6 years (11 girls, 17 boys) with Kawasaki disease and, for comparison, 30 normal children ranging in age from 1-8 years (8 girls, 22 boys) without any cardiovascular disease were included in this study. The left ventricular functions of the children were evaluated by equilibrium multigated blood pooling ventriculography (EMBPV), which was performed after in vivo labeling of red blood cells using 10 mCi Tc-99m pertechnetate. Scintigraphy was performed using a digital gamma camera with the aid of an electrocardiogram gate. The left ventricular functions were determined by Fourier analysis of the time-activity curve in the left ventricles. The parameters of the left ventricular functions included: 1) systolic phase--[a] ejection fraction (EF), [b] ejection time (ET), [c] peak ejection rate (PER), and [d] first 1/3 ejection rate mean (1/3ERM), and 2) diastolic phase--[a] peak filling rate (PFR), [b] fast filling fraction (FFF), [c] time to peak filling rate (TPFR), and [d] first 1/3 filling rate mean (1/3FRM). The results showed that no significant differences existed between the two groups in any parameter of the left ventricular function. The authors suggest that the left ventricular functions in children with Kawasaki disease are not apparently impaired. The results were proven by the presentation of the EMBPV in this study.

Topics: Case-Control Studies; Child; Child, Preschool; Erythrocytes; Female; Gated Blood-Pool Imaging; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Sodium Pertechnetate Tc 99m; Ventricular Dysfunction, Left; Ventricular Function, Left

Eleven patients diagnosed with chronic fatigue syndrome were found to have abnormal left ventricular myocardial dynamics as indicated on MUGA studies. Among the abnormalities noted were abnormal wall motion at rest and stress, dilatation of the left ventricle, and segmental wall motion abnormalities.

Topics: Adult; Electrocardiography, Ambulatory; Erythrocytes; Exercise Test; Fatigue Syndrome, Chronic; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Ventricular Dysfunction, Left