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ANSWERS
GATED
SPECT
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Answers (I)
The patient has
normal rest and stress perfusion images with no
evidence of ischaemia or prior infarction.
However, gated SPECT
reveals global hypokinesia of the left ventricle
with a global of LVEF of 35%.
This study is typical
of dilated cardiomyopathy. Perfusion at stress and
rest is normal or near normal but LV function is
depressed despite the absence of evidence of prior
infarct on the rest study.
Answers (II)
Note that without
gated SPECT imaging, the diagnosis of cardiomyopathy
would be missed, and the patient would be erroneously
classsified as normal.
In addition, the
prognosis of the patient, based on the additional
information from the gated SPECT study, has also
significantly changed. A large prognostic study
from the Cedars-Sinai group shows that patients
with LVEF < 45% by gated SPECT have an adverse prognosis
even in the presence of normal perfusion.
Prognostic significance of LVEF and Volumes
1680 patients with
rest Tl/stress MIBI gated SPECT, FU 569 days
LVEF < 45%, ESV>70
ml, EDV>120mls predicts worse outcome
LVEF > 45% despite
severe defects -> cardiac death 1% / year
LVEF < 45% with
mild/mod defects -> cardiac death 9.2% / year
LVEF < 45% plus
ESV < 70 ml -> cardiac death 1.7% / year
LVEF < 45% plus
ESV > 70 ml -> cardiac death 7.2% / year
Sharir et al Circ 1999(7);100:1035
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