Myocardial perfusion and function single photon emission computed tomography.
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Humans↗
Biomedical subjects
April Mann
Publications and source records attributed to April Mann.
Usefulness of electrocardiographic-gated stress technetium-99m sestamibi single-photon emission computed tomography to differentiate ischemic from nonischemic cardiomyopathy.
The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is frequently difficult. We examined the clinical value of stress electrocardiographic gated (ECG-gated) single-photon emission computed tomography (SPECT) to identify ischemic cardiomyopathy and detect coronary artery disease (CAD) in 164 patients without known CAD, ejection fraction < or =40% by ECG-gated SPECT, and subsequent coronary angiography. Summed stress, rest, and difference scores were measured from the SPECT studies, and regional wall motion variance was calculated from the ECG-gated images. Sensitivity and 95% confidence intervals for the diagnosis of ischemic cardiomyopathy and for detection of any CAD (>50% diameter stenosis) were estimated using previously defined cutoffs for summed stress score and regional wall motion variance. For the diagnosis of ischemic cardiomyopathy, sensitivity of stress SPECT (summed stress score >8) was 87% (95% confidence interval [CI] 78 to 95), with a specificity of 63% (95% CI 60 to 82). The addition of wall motion information (summed stress score >8 or regional wall motion variance >0.114) increased sensitivity to 88% (95% CI 80 to 96) and decreased specificity to 45% (95% CI 35 to 55). If reversibility was also taken into account (summed stress score >8, regional wall motion variance >0.114, or summed difference score >0), sensitivity further increased to 94% (95% CI 88 to 100) and specificity decreased to 32% (95% CI 23 to 41). For detection of any CAD, the combined approach using stress perfusion, reversibility, and region of wall motion had a sensitivity of 94% (95% CI 89 to 99) and a specificity of 45% (95% CI 35 to 57). Therefore, ECG-gated SPECT is very sensitive for detection of ischemic cardiomyopathy and CAD among patients with moderate to severe systolic dysfunction.
Adult↗
Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees.
BACKGROUND: Stress electrocardiography (ECG)-gated single photon emission computed tomography (SPECT) for assessment of left ventricular perfusion and function improves the confidence of interpretation and enhances specificity for detection of coronary artery disease. The reproducibility of visual interpretation of ECG-gated SPECT images and the significance of training and experience have not been reported previously in a large series of consecutive patients. We evaluated both intraobserver and interobserver agreement of interpretation of ECG-gated SPECT images among 3 cardiology trainees and 3 experienced nuclear cardiologists from 3 institutions. METHODS AND RESULTS: Three nuclear cardiologists and 3 cardiology trainees who had fulfilled American College of Cardiology/American Society of Nuclear Cardiology Core Cardiology Training Symposium (ACC/ASNC COCATS) guidelines for level II training in nuclear cardiology independently evaluated 106 consecutive technetium 99m sestamibi SPECT images with ECG gating of either the stress or rest images. All cases were interpreted blindly, twice in random sequence, without clinical data. We assessed intraobserver and interobserver agreement for myocardial perfusion, left ventricular regional and global systolic function, and overall clinical impression, by means of percent agreement and Cohen's kappa statistic. Intraobserver agreement was good (82%-92%, kappa = 0.54-0.84) for assessment of myocardial perfusion, systolic function, and overall impression. Interobserver agreement was also good, ranging from 65% to 90% (kappa = 0.32-0.76), with better agreement found for assessment of function (77%-85%, kappa = 0.52-0.7) than for perfusion (65%-80%, kappa = 0.32-0.6). For all measures, there were no significant differences in reproducibility between nuclear cardiologists and cardiology trainees. CONCLUSIONS: Interpretation of ECG-gated SPECT images has high reproducibility and agreement among both nuclear cardiologists and cardiology trainees.
Electrocardiography↗