Phase analysis of radionuclide ventriculograms for the detection of coronary artery disease

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Abstract

The value of phase analysis of multiple gated acquisition blood pool images for identifying wall motion abnormalities due to stress-induced ischemia was examined. Myocardial segments with an abnormal phase, i.e., delayed onset of wall motion, were localized on a phase distribution image of the LV and the synchrony of LV systolic wall motion was assessed from histograms of the LV phase distribution, i.e., the standard deviation (SD) from the mean of this peak, which was defined as SDP. Its upper limits of normal at rest and exercise were established in seven normals as the mean +2 SD and were 12 degrees at rest and 10 degrees at maximum exercise. Of the 56 patients, 37 had coronary artery disease (CAD), 11 had valvular disease but normal coronary arteries, and eight had normal coronary arteries, no valvular disease, but had either cardiomyopathy or typical angina. In the CAD patients, SDP was abnormal in 95% during exercise while only 86% had an abnormal ejection fraction (EF) response and/or exercise-induced wall motion abnormalities by visual interpretation. By contrast, in the 11 valvular heart disease patients, SDP was abnormal in only two despire exercise-induced wall motion abnormalities in five and an abnormal EF response in all 11. Thus although an abnormal EF response to exercise is a sensitive indicator of cardiac disease, it is, however like exercise induced wall motion abnormalities, not specific for CAD. By contrast, phase analysis not only permitted separation of wall motion abnormalities induced by ischemia from those associated with valvular disease, but was also an objective, highly sensitive, and specific indicator of regional myocardial ischemia.

References (21)

  • H Hecht et al.

    Exercise-induced regional wall motion abnormalities on radionuclide angiography: Lack of reliability for detection of coronary artery disease in the presence of valvular heart disease

    Am J Cardiol

    (1981)
  • WE Adam et al.

    Equilibrium (gated) radionuclide ventriculography

    Cardiovasc Radiol

    (1979)
  • D Pavel et al.

    Quantification of regional wall motion abnormalities (RWMA) detected by phase analysis of gated cardiac studies (abstr)

    J Nucl Med

    (1980)
  • SL Bacharach et al.

    Fourier distribution map: Toward an understanding what they mean

  • DA Gibson et al.

    Abnormal left ventricular wall movement during early systole in patients with angina pectoris

    Br Heart J

    (1976)
  • B Holman et al.

    Disruption in the temporal sequence of regional ventricular contraction

    Circulation

    (1980)
  • H Tomoike et al.

    Regional myocardial dysfunction and hemodynamic abnormalities during strenuous exercise in dogs with limited coronary flow

    Circ Res

    (1978)
  • WG Austen et al.

    A reporting system on patients evaluated for coronary artery disease

    Circulation

    (1975)
  • RC Marshall et al.

    Effect of oral propranolol on rest, exercise and post-exercise left ventricular performance in normals and patients with coronary artery disease

    Circulation

    (1980)
  • DC Champeney

    Fourier transforms and their physical applications

There are more references available in the full text version of this article.

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Supported in part by contract DE-AM06-76-SF00012 between the U.S. Department of Energy, Washington D.C., and the University of California at Los Angeles, the Swiss National Foundation of Research (Dr. Ratib), and an Award by the Greater Los Angeles Affiliate of the American Heart Association (617-IG1).

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