Determination of ventricular volumes in coronary artery disease^[*]

Summary

Aim: Comparison of two gated SPECT analysis tools – gated SPECT quantification (GSQ) and emory cardiac toolbox (ECT) – in patients with coronary artery disease (CAD) and severely impaired left ventricular function (preoperative: EF <35% by cardiac catheter). Patients, methods: A total of 56 gatedSPECT examinations (oneday hybrid-protocol with 201Tl-chloride for rest and ^99mTcsestamibi for stress applied during low-dose dobutamine stress MR-examination; temporal resolution; 8 phases per cardiac cycle) were performed in 36 patients (31 preoperatively, 25 postoperatively) and compared with MRI in 48 cases. Left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes as well as the left ventricular ejection fraction (LV-EF) were calculated. Results: The total volumetric assessment by both analysis algorithms (n = 56) showed good intraclass correlation coefficients preoperatively (n=31), but even better postoperatively (n=25). The mean reconstruction time was approximately 3 minutes (±2 SD) for GSQ and 15 minutes (±5 SD) for ECT. In comparison to MRI the results of both analysis tools also correlated well, but the agreement decreased in the presence of scared tissue. The mean LV-EF (MRI) preoperatively was 30.4%, in 6/36 patients above the values calculated from cardiac catheter, postoperatively 34.6%. Conclusion: Both gated SPECT analysis tools showed reliable volumetric assessments in high-risk patients with CAD and severely reduced LV-EF in comparison to MRI, with advantages for GSQ in terms of postprocessing time. However, for the calculation of LV-EF a markedly lower concordance with MR-results was observed for both methods depending on the presence of myocardial scars.

Zusammenfassung

Ziel: Softwarevergleich von GSQ (gated SPECT quantification) und ECT (emory cardiac toolbox) bei Patienten mit koronarer Herzerkrankung (KHK) und stark eingeschränkter Ventrikelfunktion (präoperativer Herzkatheter-EF <35%) mit der MRT. Patienten, Methoden: 36 Patienten mit KHK erhielten insgesamt 56 Gated-SPECT-Untersuchungen (31 prä-, 25 postoperativ; 1-Tages-Hybridprotokoll mit 201Tl- Chlorid in Ruhe und ^99mTc-Sestamibi nach Low-dose-Dobutamin- Belastung; zeitliche Auflösung: 8 Phasen). In 48 Fällen wurden die Ergebnisse mit der MRT verglichen. Das enddiastolische (LV-EDV) und endsystolische (LV-ESV) Volumen und die Ejektionsfraktion (LV-EF) wurden berechnet. Ergebnisse: Die beiden Auswertealgorithmen untereinander (n=56) zeigten vor der Operation (n=31) und vor allem nach vollständigen Revaskularisation (n=25) eine gute Übereinstimmung. Die Rekonstruktionsdauer mit GSQ betrug im Mittel 3 (±2 SD), mit ECT 15 Minuten (±5 SD). Im Vergleich zur MRT ergaben sich für beide Methoden gute Korrelationen, im Falle von Narbenarealen waren sie schlechter. Die präoperative LV-EF (MRT) lag im Mittel bei 30,4%, postoperativ bei 34,6% und damit bei 6/36 Patienten über den im Herzkatheter ermittelten. Schlussfolgerung: Bei KHK-Hochrisikopatienten mit stark eingeschränkter LV-EF sind valide Werte für die Volumenbestimmung – im Vergleich zum Goldstandard MRT – aus den Gated-SPECT-Daten zu erzielen, mit deutlichem zeitlichem Vorteil für GSQ. Bei der LV-EF ergab sich eine geringere Übereinstimmung je nach Ausmaß des Narbenareals.

Keywords

Gated SPECT - cardiac volumetry - cardiac MRI - myocardial scar - coronary artery disease - heart failure

Schlüsselwörter

GatedSPECT - kardiale Volumetrie - kardiale MRT - Myokardnarbe - koronare Herzerkrankung - Herzinsuffizienz

^* Diese Arbeit enthält Ergebnisse aus der Dissertation von Sebastian Mehl.

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