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$30 Abstracts Journal of Nuclear Cardiology Monday afternoon, April 19, 1999 January/February 1999, Part 2

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INFERIOR WALL ARTIFACTS IN PAKISTANIS: CENTRAL OBESITY EFFECT Nishtar. S, Khan. I. S, Shahab. S, Mattu. M. A. Pakistan Institute of Medical Sciences, Islamabad Pakistan.

THE

Objectives: To detemame the diagnostic accuracy of SPECT scanning in the diagnosis of Coronary Artery disease using Coronary Angiography as a gold standard. Methods: 49 pati~ts having tmdergone stress ThaUium-201 or Tc 99m labelled Sestamibi SPECT and coronary angiography within six months were enrolled. Coronary luminal stenosis was compared with imaging data in corresponding myocardial perfusion beds. The Left Anterior Descending artery corresponded to the Anterior wall and the Septum, the Circumflex Coronary to the Lateral wall and the Right coronary to the Inferior wall. Results: The patient population was predominantly male (81.1%%), with a mean age of 51.1 +/-10.9. SPECT scanning, in the definition of I_~ Anterior Descending Artery lesions showed a sensitivity of 97.66%, a specificity of 100% and a positive predictive value of 100%. In the definition of the Circulrrflex Coronary Artery lesions it showed a sensitivity of 94%, a specificity of 100% and a positive predictive value of 100% and in the definition of Right Coronary artery lesions, a sensitivity of 100% but a specificity of 48% and positive predictive value of 65% only. Conclusion: Central Obesity in Pakistanis with Corollary Artery

Disease may be responsible for the poor predictive value of SPECT scanning in the detection of Right Coronary Artery Disease.

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CORRELATION OF GATED SPECT IMAGING WITH TWO-DIMENSIONAL ECHOCARDIOGRAPHY IN REGIONAL AND GLOBAL LEFT VENTRICULAR WALL MOTION ASSESSMENT H Brandspiegel, J Burke, A Chevres. Lankenau Hospital, Wynnewood, PA This study compares 99m-Tc-tetrofosmin gated single photon emission computed tomography (gated SPECT) and two-dimensional echocardiography (2DE) in the assessment of regional and global left ventricular (LV) wall motion (WM). Methods: 204 consecutive patients who had both gated SPECT imaging and 2DE were evaluated. Regional and global LV WM was assessed with a 12 segment gated SPECT and a 16 segment 2DE method. We used a semiquantitative visual scoring scale for WM. Results: We found agreement between the two methods in 0.92 of the patients (kappa=0.79) in the assessment of regional WM abnormalities. McNemar comparison shows a p value of 0.049. In the assessment of global LV function, agreement was noted in 0.87. The 26 patients in whom disagreement was noted differed by only one predefined subgroup. Conclusion: Our data demonstrate that 99m-Tc-tetrofosmin gated SPECT imaging provides similar assessment of both regional and global LV function when compared to 2DE.

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TI-201 SPECT BE'lEER PREDICTS PROGNOSIS THAN DOBUTAMINE ECHOCARDIOGRAPHY V. Bouiet, J. Lipiecki, D. Mestas, E. Albuisson, F. Philippot, A. Amonchot, O. de Tauriac, N. Dural, B. Citron, J. Ponsonnaille, J. Maublant. University Hospital, Clermont-Ferrand, France

Defect size (DS), left ventdcular ejection fraction (LVEF) and wall motion (WM) after a first myocardial infarction (Mt) were prospectively compared with clinical outcome in 67 patients (pts). DS was assessed by TI-201 rest SPECT, LVEF and WM by dobutamine echocardio- graphy (DE), both performed before coronary angioptasty. Outcome, based on clinical examination, stress test and gated blood pool, was evaluated 22+_12 months later. 10% of the pts presented at least one major clinical event. DS was the most predictive factor for occurrence of major clinical event (35+18% in pts with event vs 13+13% in the others, p<0.0001), of functional status (Duke score of 42_+15 if DS<22% vs 34+_17 otherwise, p<0.05) and of duration of stress test (570+220 s if DS<22% vs 405+200 s otherwise, p<0.02). Late improvement in LVEF was better predicted by DE (ALVEF>5% had WM score of 1.45_+0.2 vs 1.64+0.4 otherwise, p<0.05). In conclusion, cardiac events and functional status in MI are better predicted by TI-201 SPECT than DE.

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Q U A N T I T A T I V E G A T E D S P E C T F I N D I N G S IN THE S E G M E N T S W I T H N O R M A L P E R F U S I O N A N D N O R M A L W A L L M O T I O N ON U C G M.Konno, I.Adachi, K.Morita, MB.Imran, T.Mochizuki, T.Kohya, N.Kubo, Y.Ito, A.Kitabatake and N.Tamaki. Hokkaido University School of Medicine, Sapporo, Japan.

Quantitative Gated SPECT (QGS) has been applied for evaluation of global and regional left ventricular (LV) function. In order to compare QGS findings with UCG findings, we evaluated the segmental wall motion (WM) on 3D surface display of QGS and UCG WM evaluated within two weeks. Resting gated SPECT was performed in 30 patients with chronic coronary artery disease (CAD), one hour after injection of 600MBq of Tc-99m MIBI. LV was divided into 9 segments (total 270 segments) and each segmental WM was assessed by 6 independent nuclear physicians to score 5 points scale from 0 (normal) to 4 (dyskinesia). Finally the average scores for each segment were used for comparison of the WM on QGS with that on UCG. There was a poor correlation between QGS and UCG WM scores (r=-0.35 p~0.01) . QGS showed abnormal WM in 21.3% (33/155) of normally perfused segments with normal WM on UCG. Such abnormality was most often observed in -apical (5/11 ; 45.5%) and septal (15/29 ; 51.7%) regions compared to other regions; anterior (7/43 ; 16.3%), inferior (4/30 ; 13.3%), lateral (2/42 ; 4.8%) region. The wall motion score in septal region on QGS was higher ( 2 . 0 2 - 0.73) than any other segment (average 1.54+0.40) (P=0.014). We conclude that WM analysis on septum and apex should be carefully evaluated for WM on QGS. Further study is needed to determine whether QGS may overestimate or US may underestimate WM abnormalities in these regions.