The Effects of Dipyridamole on Left Ventricular Function Evaluated by Stress-Rest Gated 201Tl Myocardial Perfusion SPECT

以壓力－休息鉈－201門控心肌灌注造影評估Dipyridamole對左心室功能的影響

陳宏德(Hon-Der Chen) ； 馮致中(Chih-Chung Feng) ； 楊光道(Kuang-Tao Yang) ； 洪光威(Guang-Uei Hung)

《核子醫學雜誌》 20卷3期 (2007/09) Pp. 129-135

https://doi.org/10.6332/ANMS.2003.002

摘要

Background: Gated myocardial perfusion SPECT simultaneously evaluates myocardial perfusion at tracer injection and ventricular function at imaging. Stress imaging is usually performed immediately after tracer injection with 201Tl, but 30 to 60 min later with (superscript 99m)Tc tracers. Therefore, 201Tl gated SPECT seems to have more chance to detect the functional changes caused by stress procedures. The purpose of this study was to evaluate the effects of dipyridamole on left ventricular function by stress-rest gated 201Tl myocardial perfusion SPECT. The results were correlated with the coronary angiographic findings.
Methods: The study retrospectively included 150 patients who underwent dipyridamole 201Tl gated SPECT and coronary angiography within 3 months. Post-stress and 4-h rest images were obtained and left ventricular ejection fraction (LVEF) was calculated by automated software (QGS 3.0). Summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were used for describing perfusion abnormalities. The patients were further divided into three groups according to the difference of LVEF (△ LVEF) between post-stress and rest images. Group A: △LVEF≥5%, group B: 5%＞△LVEF＞-5%, group C: △LVEF≤-5%. The patients were thought to have signify significant coronary artery disease (CAD) when coronary angiography showed≥70% stenoses in at least one vessel.
Results: There were 43 patients (29%) in group A, 63 (42%) in group B, and 44 (29%) in group C. SSS of the three groups were 9.77±9.90, 12.05±10.37 and 17.07±11.89 (group A, B and C); SRS were 6.28±7.88, 6.03±6.64 and 7.02±7.33; and SDS were 3.49±4.53, 6.02±7.72 and 10.05±10.37. The SSS and SDS of group C were significantly higher than those of group A and B (P＜0.05), but SRS was not significantly different between the three groups. Significant CAD was noted in 21 patients (49%) for group A, 38 (62%) for group B, and 36 (82%) for group C. Chi-square test for trend showed significant difference (P＜0.01) between the three groups of patients.
Conclusions: Dipyridamole may cause transient increase or decrease of LVEF. In addition, the dipyridamole-induced decrease of LVEF shown on post-stress and rest gated 201Tl SPECT was significantly correlated to myocardial ischemia and significant CAD.

關鍵字

鉈－201 ； 備鎮心壓力試驗 ； 門控單光子斷層掃描 ； 左心室射出分率

並列摘要

Background: Gated myocardial perfusion SPECT simultaneously evaluates myocardial perfusion at tracer injection and ventricular function at imaging. Stress imaging is usually performed immediately after tracer injection with 201Tl, but 30 to 60 min later with (superscript 99m)Tc tracers. Therefore, 201Tl gated SPECT seems to have more chance to detect the functional changes caused by stress procedures. The purpose of this study was to evaluate the effects of dipyridamole on left ventricular function by stress-rest gated 201Tl myocardial perfusion SPECT. The results were correlated with the coronary angiographic findings.
Methods: The study retrospectively included 150 patients who underwent dipyridamole 201Tl gated SPECT and coronary angiography within 3 months. Post-stress and 4-h rest images were obtained and left ventricular ejection fraction (LVEF) was calculated by automated software (QGS 3.0). Summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were used for describing perfusion abnormalities. The patients were further divided into three groups according to the difference of LVEF (△ LVEF) between post-stress and rest images. Group A: △LVEF≥5%, group B: 5%＞△LVEF＞-5%, group C: △LVEF≤-5%. The patients were thought to have signify significant coronary artery disease (CAD) when coronary angiography showed≥70% stenoses in at least one vessel.
Results: There were 43 patients (29%) in group A, 63 (42%) in group B, and 44 (29%) in group C. SSS of the three groups were 9.77±9.90, 12.05±10.37 and 17.07±11.89 (group A, B and C); SRS were 6.28±7.88, 6.03±6.64 and 7.02±7.33; and SDS were 3.49±4.53, 6.02±7.72 and 10.05±10.37. The SSS and SDS of group C were significantly higher than those of group A and B (P＜0.05), but SRS was not significantly different between the three groups. Significant CAD was noted in 21 patients (49%) for group A, 38 (62%) for group B, and 36 (82%) for group C. Chi-square test for trend showed significant difference (P＜0.01) between the three groups of patients.
Conclusions: Dipyridamole may cause transient increase or decrease of LVEF. In addition, the dipyridamole-induced decrease of LVEF shown on post-stress and rest gated 201Tl SPECT was significantly correlated to myocardial ischemia and significant CAD.

並列關鍵字

thallium 201 ； dipyridamole stress test ； gated SPECT ； LVEF