Key result
Gated SPECT detects occult LV dysfunction in ~15% of CAD patients without prior MI.
Why the study?
Left ventricular dysfunction in patients without prior myocardial infarction is commonly due to hypertension, valvular disease, or hibernating myocardium, and the ability of technetium-99m sestamibi gated SPECT to detect occult LV dysfunction needed evaluation.
Observational (n=272)
Gated SPECT detects occult LV dysfunction in 15% of CAD patients without prior MI; leaves open its value for risk stratification.
BACKGROUND: In the absence of a prior history of myocardial infarction (MI), left ventricular (LV) dysfunction is commonly due to hypertension, valvular heart disease, or hibernating myocardium. HYPOTHESIS: Since technetium-99m sestamibi gated single-photon emission computed tomography (SPECT) may be used to determine both stress/rest myocardial perfusion and resting LV function, we attempted to evaluate the ability of gated SPECT imaging to detect occult LV dysfunction. METHODS: We evaluated the ability of this technique to detect occult LV dysfunction among 179 patients without history MI and angiographically documented coronary artery disease (CAD). All patients underwent both gated SPECT and cardiac catheterization within a 6-month time period. Left ventricular volume and ejection fraction (EF) values were determined according to a previously validated technique using Simpson's rule. Normal limit values for LV volumes and EF were derived from a control population of 93 patients with normal coronary angiograms. RESULTS: Based on normal limit-derived criteria, 15% of the CAD study cohort had occult LV dysfunction (> 2 standard deviations below gender-specific normal limit means for LVEF). Mean LV end-diastolic volume index (EDVi) was significantly increased (p < 0.05) and LVEF decreased (p < 0.05) in patients with triple-vessel CAD. End-diastolic volume index was also increased in the cohort of patients with both hypertension and LV hypertrophy (LVH) (p < 0.05). However, multivariate logistic regression analysis revealed that only CAD extent, but not hypertension or LVH, was a significant predictor of occult LV dysfunction (p = 0.009). CONCLUSION: Occult LV dysfunction can be detected in patients with CAD by gating technetium-99m sestamibi SPECT studies, and its presence may signify the presence of extensive CAD.
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Yao et al. (2002) conducted an observational in Coronary artery disease without prior myocardial infarction (n=272). Technetium-99m sestamibi gated SPECT vs. Normal coronary angiograms (control population) was evaluated on Occult left ventricular dysfunction (> 2 standard deviations below gender-specific normal limit means for LVEF) (p=0.009). Technetium-99m sestamibi gated SPECT detected occult left ventricular dysfunction in 15% of patients with CAD and no prior MI, with CAD extent being a significant predictor (p=0.009).
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