Assessment of Left Ventricular Function in Coronary Artery Disease with Nuclear Techniques

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Project Type

Coordinated Research Project

Project Code




Approved Date

6 March 2007



Start Date

15 September 2007

Expected End Date

31 December 2011

Completed Date

8 February 2012


Coronary Artery Disease (CAD) is the leading cause of death in many developing countries, and prevalence of the disease is increasing as economic conditions change. Early detection and prognosis using non-invasive, widely available procedures may have an impact in patient management and cast-effectiveness. The use of stress perfusion SPECT imaging represents an admitted powerful diagnostic and prognostic tool.
Patients with ischemic cardiomyopathy and severe ventricular dysfunction have poor prognosis and their management is guided mainly by the presence of myocardial viability, which defines the referral to either revascularization or medical therapy. On the other hand, patients with normal LV function are risk-stratified mainly according to the result of the perfusion scan and the extension and severity of perfusion defects. The group of patients with mild-to-moderate LV dysfunction may potentially benefit from additional parameters for a correct stratification. The purpose of our study is to investigate the feasibility, reproducibility and accuracy of early acquisition of gated perfusion SPECT after stress as compared to the routine delayed acquisition in order to improve the detectability of transient myocardial dysfunction (stunning). An additional aim is to confirm the prognostic value of myocardial stunning in a population of patients with known or suspected CAD and with mild-to-moderate ventricular dysfunction. Secondary expected outcomes are the diffusion of the technique in developing countries, as well as the improvement of skills of interpreting physicians and the awareness of the utility of the test among referring cardiologists since CAD will remain still an emerging health problem in these regions and the method would contribute to improve patient management and cost-effectiveness of medical care.


The main objective of this multi-centre, international study (sponsored by IAEA) was to evaluate whether early post-stress imaging increases the detection of myocardial stunning as compared to standard acquisition, without compromising the diagnostic quality of the images obtained from G-SPECT in patients with known or suspected CAD and intermediate-to-high risk exercise test results. An additional objective was to unify the protocols leading institutions in several member states, mainly from developing regions

Specific objectives

To assess the incremental prognostic value of transient LV dysfunction over other nuclear, clinical and exercise data

To evaluate the feasibility, image quality and functional parameters obtained by early post-stress GSPECT acquisition and compare them to those obtained by the standard acquisition

To improve the detection of transient ischemic-induced systolic dysfunction after exercise, by performing early GSPECT acquisition


It is projected that CAD mortality rates will double from 1990 to 2020, with approximately 82% of the increase attributable to the developing world. It is suggested that rapid socioeconomic growth in emerging countries increases exposure to risk factors for CAD. Thus, precise identification of high- risk patients may have an impact not only in survival rates but also in cost-savings, which represents a major issue in regions with low economic resources and limited availability of high-tech revascularization procedures


The results of our investigation suggest that early post-exercise imaging retains most quality attributes and perfusion information compared to late acquisition, since perfusion scores were exactly the same in >95% of cases. Furthermore, early acquisition was able to detect a greater decrease in post-exercise LVEF in ischemic patients. Even though the average difference between ?-LVEF at Stress-1 and Stress-2 was moderate, LVEF significantly decreased in the ischemic patients

CRP Publications


Scientific Paper


Dec 2014


Detection of post-exercise stunning by early G-SPECT myocardial perfusion imaging: Results from the IAEA multi-centre study’ in the Journal of Nuclear Cardiology




Scientific Paper


Feb 2009


Site of myocardial infarction and severity of perfusion abnormalities impact on post-stress left ventricular function in patients with single-vessel disease: gated single-photon emission computed tomography MIBI



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