A Comparison of Myocardial Perfusion Gated SPECT Studies Obtained at Rest and after Stress

Abstract

Objective: To perform a comparison between post-stress and rest gated single-photon emission computer tomography (SPECT) myocardial perfusion imaging (MPI) studies to assess post-stress stunning and the variables underlying this phenomenon. Subjects and Methods: This was a prospective study of 318 consecutive adult patients undergoing stress and rest gated SPECT using a 2-day ^99mTc-tetrofosmin protocol. Bruce protocol treadmill stress (n = 93) or i.v. dipyridamole pharmacologic stress (n = 225) were used as stressors. Ejection fractions (EF) and left ventricular (LV) end-diastolic (EDV) and end-systolic volumes (ESV) were calculated using the Cedars Sinai Quantitative Gated SPECT software. Perfusion defects were visually scored using a 20-segment model to obtain summed stress scores. Statistical analysis was performed by applying paired t test and multi-regression. Statistically significant (p < 0.05) paired differences between post-stress and rest EF and ESV and type of stressing were noted. Results: Analysis of patient groups based on the type of stress showed significantly low EF on post-stress studies for both treadmill and dipyridamole stressing and also significantly high ESV on post-stress studies for dipyridamole. Multi-regression analysis using differences in post-stress and rest EF, EDV and ESV as dependent and summed stress scores, type of stress, delay time, previous myocardial infarction and size of LV as independent variables showed statistically significant associations between high summed stress scores (>13) and size of post-stress LV for EDV and ESV differences. High volumes were noted on post-stress studies. The magnitudes of the observed differences were well within the reproducibility of LV volume calculations. Conclusions: Patients showing stunning had significant ischemia or a dilated LV. The stunning manifested as high EDV and ESV differences. The magnitude of the differences observed in EF and LV volumes were not clinically significant.