Gating failure can result in underestimation of cardiac function in myocardial perfusion scintigraphy
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¨t Nuklearmedizinische Klinik und Poliklinik Klinikum rechts der Isar der Technischen Universita ¨ nchen, Munich, Germany Mu ¨ r Herz-Kreislauf-Forschung e.V. Partner site Munich Heart Alliance, Deutsches Zentrum fu Munich, Germany
Received Oct 21, 2020; accepted Oct 21, 2020 doi:10.1007/s12350-020-02430-8
Here, we present a case with a pacemaker due to an atrioventricular (AV) block 2 Mobitz type, in whom a gating failure resulted in a relevant underestimation of cardiac function in myocardial perfusion scintigraphy. A set of quality control steps for gating errors is proposed.
INTRODUCTION
PATIENT CONDITION
Myocardial perfusion scintigraphy (MPI) is an established tool in the diagnosis and prognosis of ischemic disease. Apart from perfusion, ECG-gated MPI provides information on cardiac function. Importantly, regional and global systolic left ventricular (LV) function is a powerful prognostic factor on its own.1,2 In addition, ECG-gated acquisitions are helpful in estimation attenuation artifacts. In ECG-gated MPI, detected events are prospectively synchronized with the electrocardiogram (ECG) to sort the events into a series of contractile phase bins. Specifically, R-waves as detected in the ECG are used to split RR intervals in typically 8 or 16 phases.3 A failure in this step can result in a significant underestimation of cardiac function as demonstrated here in a patient with a pacemaker. We propose a set of quality control steps covering technical and imaging aspects.
A female patient (77 years old, 165 cm, 68 kg) with a high cardiovascular risk profile and progressive dyspnea was referred to our department for evaluation of suspected ischemic heart disease. She had been diagnosed with cerebral and peripheral vascular disease, diabetes mellitus type II, arterial hypertension, hypercholesterolemia, and nicotine consumption. A two chamber pacemaker due to AV-Block 2 type Mobitz was implanted 25 months ago. A recent echocardiogram report described normal regional and global systolic LV function.
Reprint requests: Alberto Villagran Asiares, MSc, Nuklearmedizinische Klinik und Poliklinik Klinikum rechts der Isar der Technischen Universita¨t Mu¨nchen, Munich, Germany; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 The Author(s)
PROTOCOL Pharmacological stress was performed with a 47.6 mg adenosine infusion over 5 minutes (0.14 mgkgmin) while monitoring the patient with a 12-lead ECG (diagnostic ECG). Initial heart rate was 80 bpm, blood pressure 110/70 mmHg, which increased in 2.5 minutes to 120 bpm when 180 MBq Tc-99m-MIBI Sestamibi were injected. After 107 minutes, the patient underwent the first ECG-gated SPECT acquisition for 15 minutes, 18 minutes later, 534 MBq Tc-99m-MIBI Sestamibi were injected in rest followed with a delay of 15 minutes for the 5 minutes SPECT scan. Both scans were acquired on a D-SPECT camera (Spectrum Dynamics, Caesarea, Israel) in identical upright positions. The MPI acquisition was ECG gated using a 3-lead cardiac triggering
Villagran Asiares
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