QCVC Committees Scientific Activities Central Hall General Information FAC Thematic Units Arrhythmias and Electrophysiology Basic Research Bioengineering and Medical Informatics Cardiac Surgical Intensive Care Cardiovascular Nursing Cardiovascular Surgery Chagas Disease Echocardiography Epidemiology and Cardiovascular Prevention Heart Failure Hemodynamics - Cardiovascular Interventions High Blood Pressure Ischemic Heart Disease Nuclear Cardiology Pediatric Cardiology Peripheral and Cerebral Vascular Diseases Sports Cardiology Transdisciplinary Cardiology and Mental Health in Cardiology Others Brief Communications SPECT Radionuclide Ventriculography in Cardiomyopathies Assessment. Massardo T., Lavados H., Jaimovich R., Rau M. C., Alay R., Gutiérrez D., Rodríguez J. C., Sepúlveda L. University of Chile Clinical Hospital, Santiago de Chile, Chile Introduction Equilibrium radionuclide ventriculography is a reproducible and exact technique for systolic function measurement. SPECT tomography has the advantage of quantifying biventricular volumes. Main Goal To assess the current utility of planar and SPECT techniques in cardiomyopathy evaluation, comparing ejection fractions (EF) and volumes. Method: 22 cardiomyopathy studies were included (11 males, 9 females; age: 47.9±17 y.o.), with diverse dilation degree [2 non compacted (1 of them with severe coronary disease), 2 hypertrophic and 2 myocarditis] 67% of them were NYHA >II; 16 patients with valvulopathy and 10 with pulmonary hypertension. There were 8 studies pre or post cardiac transplant and 7 with pacemakers for possible resynchronization. Equipment: A double-head Siemens camera and QBS software were used. The gold standard was the planar method; volumes were calculated using count-based method, without blood sampling. Results - EF for left and right ventricles (LV and RV) as well as final diastolic and systolic volumes (EDV and ESV) did not show statistical difference between both planar and SPECT techniques. (LVEF: r= 0.83; RVEF: r=0.61; LV volumes: r=0.86). - The planar values ranged between: 10-58% for LVEF manual; 97-429ml for LV EDV; 42-370ml for LV ESV. The mean LVEF Ventricular motion was normal in 1 LV and 6 RV. In all patients with concomitant cardiac imaging (echocardiography, radiological ventriculography/coronariography or magnetic resonance) global function and motion were concordant (r LVEF eco/planar=0.59).
Clinical conduct change was based, in part, on radionuclide ventriculography confirming ventricular function in complex cases, resynchronizing pacemakers or defining conduct regarding cardiac transplant. See clinical case. Conclusions - Radionuclide ventriculography is helpful in evaluation and decision-making in cardiomyopathies. - SPECT adds more information than planar technique, obtaining better correlation for LVEF and LV volumes. Clinical Case: 70 y o female, with subit dyspnea and precordial pain. She had right ventricular overload in the EKG and high clinical probability of pulmonary embolism (PE). Admitted in hospital. Echocardiography 2D showed basal septum and lateral wall left ventricular (LV) akinesia and right ventricular (RV) hypokinesia; left atrium dilation and severe pulmonary hypertension. Left ventricular ejection fraction (LVEF): 25% - Therapy: IV Streptokinase (SK) - EKG: Q waves in the inferior wall and anteroseptal ischemia - Cardiac enzymes: Normal - Basal VQ scan: high probability of PE. Control VQ 2d post SK: no changes See Figure 1 Se continues with Congestive Heart Failure (CHF). Her echocardiogram had no significant changes. The coronary angiogram was normal. She was discharged at day 30. Fifteen days later, she was admitted in hospital again with decompensate CHF. - Cardiac Echo: dilated right chambers; normal size LV, paradoxical septum LVEF: 32% Rest perfusion tomography with 99m Tc-Sestamibi demonstrated only diffuse septal perfusion abnormality and dilated RV; LVEF: 24%. - Control Echo: evidence of intracardiac thrombus in RV; LVEF:25%. See Figure 2
A cardiac biopsy was reported as myocarditis viral? Then, she presented AV progressive blockade - Therapy: DDD Pacemaker and anticoagulation A Planar and SPECT multigated ventriculography (MUGA) was required to evaluate eventual resynchronization. It showed global dilation. LVEF: 19% and RVEF: 15%. See Figure 3.
She requires resynchronization Another control MUGA, one month later was performed showing LVEF: 8% and RVEF: 20% A new resynchronization was necessary. Final Diagnosis: CHF III-IV Sub-massive PE treated with thrombolysis Sub-acute myocarditis Therapy: Full depletion, inotropics, anticoagulants, bicameral pacemaker Evolution: As outpatient she was better, in control. Publication: October 2007 Your questions, contributions and commentaries will be answered by the lecturer or experts on the subject in the Ischemic Heart Disease list. Please fill in de form and Press the "Send" button. Question, contribution or commentary: Name and Surname:
Country: Argentina E-Mail address: Re-type Email address: Send Erase 1994-2007 CETIFAC - Bioingeniería UNER - Webmaster - HonCode - pwmc Updated: 10/17/2007