Impact of imaging protocol on left ventricular
ejection fraction using gated-SPECT myocardial
C. Marcassa, MD,
R. Giubbini, MD,
W. Acampa, MD,
C. Cittanti, MD,
O. Djepaxhija, MD,
A. Gimelli, MD,
A. Kokomani, MD,
G. Medolago, MD,
E. Milan, MD,
and R. Sciagra
Cardiology Department, S. Maugeri Fnd, IRCCS, Scientiﬁc Institute of Veruno, Veruno, Italy
Department of Medical Imaging, University and Spedali Civili, Brescia, Italy
Department of Advanced Biomedical Sciences, University ‘‘Federico II’’, Naples, Italy
Nuclear Medicine Unit, Department of Morphology, Surgery and Experimental Medicine,
University of Ferrara, Ferrara, Italy
Fondazione Toscana G. Monasterio, Pisa, Italy
Nuclear Medicine Dept, Bergamo, Italy
Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences,
University of Florence, Florence, Italy
Received Dec 16, 2015; accepted Feb 2, 2016
Background. There are limited data on the impact of the imaging protocol (single-day
stress-rest, SD, vs. dual-day, DD) on the change in left ventricular (LV) ejection fraction (EF)
(post-stress-rest) in relation to ischemia and on outcome.
Methods. Using propensity score matching procedure, 490 of 1121 patients with known
CAD, undergoing a SD or a DD in a multicenter study, were evaluated. Stress and rest gated-
SPECT myocardial perfusion imaging was used to quantify LV perfusion, EF, and volumes.
Outcome was assessed at an average follow-up time of 3.2 years.
Results. Post-stress LVEF in SD and DD were comparable across all degrees of ischemia.
The change in LVEF in patients with severe ischemia was, however, higher in the DD protocol,
independent of the extent of CAD. At follow-up, 240 patients (49.0%) required coronary
revascularization (CR) and 52 patients (10.6%) had hard events. The ischemic burden was
independently associated with CR and hard-events; the post-stress LVEF was associated with
CR but the change in EF was not predictive of either CR or hard events.
Conclusions. In patients with severe ischemia, underestimation of post-stress myocardial
stunning could be observed with the SD protocol. Post-stress LVEF and the extent ischemia, but
not the change in EF, are predictive of CR and hard events. (J Nucl Cardiol 2017;24:1292–301.)
Key Words: Gated-SPECT
Æ myocardial perfusion imaging Æ prognosis Æ study protocol
On behalf of The Italian Working Group of Nuclear Cardiology.
Reprint requests: C. Marcassa, MD, Cardiology Department, S.
Maugeri Fnd, IRCCS, Scientiﬁc Institute of Veruno, Italy;
Copyright Ó 2016 American Society of Nuclear Cardiology.