Ml For End-diastolic Volume Research Articles

Electrocardiogram-gated single-photonemission computed tomography versus cardiacmagnetic resonance imaging for the assessmentof left ventricular volumes and ejection fraction: A meta-analysis

ObjectivesThe purpose of this study was to evaluate the accuracy of electrocardiogram (ECG)-gated single-photon emission computed tomography (SPECT) for assessment of left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) compared with the gold standard of cardiac magnetic resonance imaging (MRI). BackgroundSeveral comparisons of ECG-gated SPECT with cardiac MRI have been performed for evaluation of LV volumes and EF, but each has considered few subjects, thus leaving uncertainty about the frequency of discrepancies between the two methods. MethodsWe performed a meta-analysis of data on 164 subjects from nine studies comparing ECG-gated SPECT versus cardiac MRI. Data were pooled in correlation and regression analyses relating ECG-gated SPECT and cardiac MRI measurements. The frequency of discrepancies of at least 30 ml in EDV, 20 ml in ESV and 5% or 10% in EF and concordance for EF ≤40% versus >40% were determined. ResultsThere was an overall excellent correlation between ECG-gated SPECT and cardiac MRI for EDV (r = 0.89), ESV (r = 0.92) and EF (r = 0.87). However, rates of discrepancies for individual subjects were considerable (37% [95% confidence interval {CI}, 26% to 50%] for at least 30 ml in EDV; 35% [95% CI, 23% to 49%] for at least 20 ml in ESV; 52% [95% CI, 37% to 63%] for at least 5% in EF; and 23% [95% CI, 11% to 42%] for at least 10% in EF). The misclassification rate for the 40% EF cutoff was 11%. ConclusionsElectrocardiogram-gated SPECT measurements of EDV, ESV and EF show high correlation with cardiac MRI measurements, but substantial errors may occur in individual patients. Electrocardiogram-gated SPECT offers useful functional information, but cardiac MRI should be used when accurate measurement is required.

Comparison between ECTb and QGS for assessment of left ventricular function from gated myocardial perfusion SPECT

Background. The most widely distributed software packages to compute left ventricular (LV) volume and ejection fraction (EF) from gated perfusion tomograms are QGS and the Emory Cardiac Toolbox (ECTb). Because LV modeling and time sampling differ between the algorithms, it is necessary to document relationships between values produced by them and to establish normal limits individually for each software package in order to interpret results obtained for individual patients. Methods and Results. Gated single photon emission computed tomography technetium 99m sestamibi myocardial perfusion studies were collected and analyzed for 246 patients evaluated for coronary artery disease. QGS and ECTb values of ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume were found to correlate linearly (r = 0.90, 0.91, and 0.94, respectively), but EF and EDV were significantly lower for QGS than with ECTb (53% ± 13% vs 61% ± 13 and 102 ± 45 mL vs 114 ± 50 mL, respectively). To compare calculations for healthy subjects between the two software packages, data were also selected for 50 other patients at low likelihood for coronary artery disease, for whom EF and EDV were significantly lower for QGS compared with ECTb (62% ± 9% vs 67% ± 8% and 84 ± 26 mL vs 105 ± 33 mL, respectively). The ECTb lower limit was 51% for EF and the upper limits were 171 mL for EDV and 59 mL/m2 for mass-indexed EDV, compared with limits of 44%, 137 mL, and 47 mL/m2 for QGS. Conclusions. Although correlations were strong between the two methods of computing LV functional values, statistical scatter was substantial and significant biases and trends observed. Therefore, when both software packages are used at the same site, it will be important to take these differences into consideration and to apply normal limits specific to each set of algorithms. (J Nucl Cardiol 2002;9:285-93.)

Two- and three-dimensional CT ventriculography: a new application of helical CT.

We propose a new application of helical CT, CT ventriculography, which can produce two-dimensional (2D) and three-dimensional (3D) images of different cardiac phases (plus animation). We sought to determine the accuracy of CT ventriculography for assessing left ventricular volumes. With a single breath-hold, the patient's entire heart was scanned with an ECG-gating technique (3-mm-thick collimation, 2 mm per rotation table speed, 0.8 sec per rotation, and 50 rotations through 10 cm in total). Using a 0.2-mm (0.08-sec) interval (10 slices per rotation) overlapping reconstruction, about 500 axial slices were obtained and reordered to separate different cardiac cycles. Then, 2D cardiac axes and 3D images were reconstructed and animated movies of the 2D and 3D images were produced. In 21 patients, the left ventricular end-diastolic volume, end-systolic volume, and ejection fraction were assessed and compared with left ventriculography. Correlations and agreements between CT and left ventriculography were determined. Close correlations between CT and left ventriculography were obtained (r = 0.95, 0.98, and 0.91, for end-diastolic volume, end-systolic volume, and left ventricular ejection fraction, respectively; p < 0.0001 for all values). The limits of agreement between CT and left ventriculography were 44.3 to -44.5 ml for end-diastolic volume, 19.8 to -29.0 ml for end-systolic volume, and 19.7% to -9.5% for left ventricular ejection fraction. This cardiac application of helical CT provides a clear morphology along the cardiac axes and 3D images and an assessment of left ventricular volumes (end-diastolic volume, end-systolic volume, and left ventricular ejection fraction).

Combined Tc-99m sestamibi first-pass radionuclide angiography and cardiac SPECT imaging during arbutamine infusion delivered by a computerized closed-loop system.

This study evaluated the feasibility, hemodynamic responses, and relation of combined Tc-99m sestamibi SPECT imaging and first-pass radionuclide angiography during the infusion of a new beta agonist arbutamine. Arbutamine was administered to 15 patients and constantly adjusted by a closed-loop computerized system. Rest and arbutamine Tc-99m sestamibi radionuclide angiography was performed with a multicrystal gamma camera followed by SPECT imaging with a rotating triple-head, single-crystal gamma camera. The mean differences (paired t-test) between rest and arbutamine studies for heart rate (HR), end-diastolic volume (EDV), stroke volume (SV), cardiac output (CO), and ejection fraction (EF) were as follows: 55 bpm for HR (P < 0.001), 5 ml for EDV (P=ns), 7.5 ml for SV (P=0.04), 4.4 l/min for CO (P < 0.001), and 6.4% for EF (P < 0.001), respectively. The results of SPECT studies were abnormal in six patients and normal in nine. Findings of radionuclide angiography were normal in 12 patients and abnormal in three. Interpretation of the perfusion and functional studies were concordant in 10 and discordant in five patients. Simultaneous cardiac radionuclide angiography and SPECT imaging are feasible during arbutamine infusion. This potent beta agonist increases cardiac output through a chronotropic effect with no significant changes in EDV. The discordance in SPECT and radionuclide angiography results may represent incremental diagnostic and prognostic information provided by both studies.

Left ventricular volume and endocardial surface area by three-dimensional echocardiography: Comparison with two-dimensional echocardiography and nuclear magnetic resonance imaging in normal subjects

Objectives. We evaluated a three-dimensional echocardiographic method for ventricular volume and surface area determination that uses polyhedral surface reconstruction. Six to eight nonparallel, unequally spaced, nonintersecting short-axis planes were positioned with a line of intersection display to overcome limitations associated with two-dimensional echocardiography.Background. Two-dimensional echocardiographic methods of ventricular volume and surface area determination are limited by assumptions about ventricular shape and image plane position.Methods. Left ventricular end-diastolic and end-systolic volumes and endocardial surface areas determined by three-dimensional echocardiography and nuclear magnetic resonance (NMR) imaging were compared in 15 normal subjects (7 men, 8 women, aged 23 to 41 years, body surface area 1.38 to 2.17 m2). Ten of these subjects also underwent two-dimensional echocardiography; and end-diastolic and end-systolic volumes were determined by the apical biplane summation of discs method and compared with results of NMR imaging.Results. Interobserver variability was 5% to 8% for three-dimensional echocardiography and 6% to 9% for NMR imaging. Both methods were in close agreement on end-diastolic volume (r = 0.92, SEE = 6.99 ml) and end-systolic volume (r = 0.81, SEE = 4.01 ml) and on end-diastolic surface area (r = 0.84, SEE = 8.25 cm2) and end-systolic surface area (r = 0.84, SEE = 4.89 cm2). Three-dimensional echocardiography and NMR imaging correlated significantly better for end-diastolic volume (r = 0.90, SEE = 7.0 ml) and end-systolic volume (r = 0.88, SEE = 3.1 ml) than did two-dimensional echocardiography and NMR imaging (r = 0.48, SEE = 20.5 ml for end-diastolic volume; r = 0.70, SEE = 5.6 ml for end-systolic volume).Conclusions. Three-dimensional echocardiography is an in vivo method of measuring left ventricular end-diastolic and end-systolic volumes and endocardial surface area with results comparable to those of NMR imaging. Additionally, three-dimensional echocardiography is superior to the two-dimensional echocardiographic apical biplane summation method because the technique eliminates geometric assumptions and image plane positioning error.

Effect of streptokinase on left ventricular modeling and function after myocardial infarction: The GISSI (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico) trial

It has been shown that streptokinase administration at the time of acute myocardial infarction reduces mortality significantly, and that this reduction in mortality should be related to salvage of jeopardized myocardium and preservation of left ventricular function. To better define the relation between thrombolytic therapy and left ventricular modeling and function after acute myocardial infarction, 331 consecutive patients enrolled in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico trial were studied by two-dimensional echocardiography just before discharge from the hospital. A 6 month follow-up examination was also available in 232 of these patients. Ventricular volumes were computed from an apical four chamber view, according to a previously published algorithm. An infarct size index was also semiquantitatively assessed, according to the number of akinetic and dyskinetic segments in an 11 segment left ventricular model.At predischarge examination, the 161 patients assigned to streptokinase treatment showed smaller ventricular volumes (end-diastolic volume 119.3 ± 49.7 versus 134.5 ± 57.8 ml [p = 0.011]; end-systolic volume 65.4 ± 36.4 versus 74.9 ± 45.7 ml [p = 0.036]) and smaller regional wall motion index (2.2 ± 1.9 versus 2.7 ± 1.9 segments; p = 0.019) compared with values in the 170 patients assigned to standard care; there was no difference in ejection fraction (46.6 ± 14.1 versus 45.9 ± 14.9%; p = 0.64). For both groups of patients, there was a significant relation between end-systolic volume and regional wall motion index (p < 0.001); for large and similar extents of infarct size, ventricular volume was smaller in patients assigned to thrombolytic treatment than in patients assigned to standard care.At 6 months' follow-up, the differences in volume and regional dysfunction detected at the early examination persisted: 110.8 ± 47.6 versus 127.9 ± 53.8 ml for enddiastolic volume (p = 0.001), 56.3 ± 33.6 versus 69.4 ± 42.1 ml for end-systolic volume (p = 0.001) and 1.8 ± 1.8 versus 2.3 ± 1.8 segments for regional wall motion index (p = 0.001). Again, for comparable extents of infarct size, end-systolic volume was smaller in patients who received streptokinase (n = 110) than in those assigned to conventional treatment (n = 122).It is concluded that streptokinase improves left ventricular modeling and function in patients with myocardial infarction, reducing the extent of regional wall motion abnormalities and lessening postinfarction ventricular dilation. The beneficial effects persist up to 6 months.