Although exercise LV function testing had less diagnostic value for the detection of coronary artery disease than initially anticipated, peak exercise LVEF had important prognostic value in patients with variety of cardiac diseases. Over the subsequent years, exercise ERNA was used less and less for diagnosing coronary artery disease. The imaging procedure was fully standardized and required only a few minutes of camera time, and LVEF values were highly reproducible.
When in the early s echocardiography became a routine part of clinical cardiology, the use of resting ERNA decreased further. Echocardiographic equipment was smaller and more mobile; studies were performed under direct supervision of cardiologists. I believe that there was another reason why the clinical use of ERNA decreased. As a consequence, potential customers were lost and with it the clinical demand for ERNA withered.
Additionally, with the advent of Tcm-labeled myocardial perfusion imaging agents, the focus of the nuclear cardiology community was directed at SPECT imaging.
Planar imaging was no longer state of the art and became all but obsolete. In recent years, novel dedicated cardiac SPECT cameras with multiple solid-state detectors, designed to acquire 3-dimensional image data, were introduced in clinical practice. These devices offer the benefit of improved count sensitivity, spatial and energy resolution, shortened imaging time, and reduced patient radiation exposure. The downside of this development was that laboratories no longer could provide time-tested planar imaging procedures, such as ERNA.
Regrettably many laboratories have abandoned regular use of ERNAs or have limited experience. Additional approved, but less frequently requested, clinical indications for ERNA are assessment of global and regional LV function in patients with recent or old infarction, in patients with congestive heart failure, and in patients who are potential candidates for implantation of defibrillator.
The resulting gated planar images can be processed using standard planar ERNA analysis software. They found good overall correlations i. Had they used cycle-dependent background correction, these dynamic parameters could have been calculated as well. Because of the complex morphology of the right ventricle RV and overlap with other cardiac chambers, reliable assessment of RVEF since long has been recognized as being problematic using planar ERNA.
I agree with the conclusion that re-projection of 3D data onto a 2D plane may allow for substituting planar ERNA imaging. This approach has the advantage that a well-validated imaging procedure and analysis of LV function may find continued clinical use. References 1. A scintigraphic method for measuring left ventricular ejection fraction in man without cardiac catheterization. Am J Cardiol ; A new technique for the calculation of left ventricular ejection fraction. J Nucl Med ; PubMed Google Scholar 3.
Measurement of left ventricular ejection fraction. PubMed Google Scholar 4. Noninvasive nuclear kinecardiography. PubMed Google Scholar 5. High temporal resolution ECG-gated scintigraphic angiocardiography. PubMed Google Scholar 6. Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging.
Comparison to contrast angiography. Circulation ; R-wave synchronized blood pool imaging: A comparison of the accuracy and reproducibility of fixed and computer-automated varying regions-of-interest for determining the left ventricular ejection fraction. Radiology ; CrossRef Google Scholar 8. Rapid radionuclide-derived systolic and diastolic cardiac function using cycle-dependent background correction and Fourier analysis. In: Proceedings of computers in cardiology.
Google Scholar 9. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary artery disease. New Engl J Med ; Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease.
Comparison with exercise electrocardiography. Myocardial imaging with Thallium a multicenter study in patients with angina pectoris or acute myocardial infarction. The declining specificity of exercise radionuclide ventriculography. These data have significant implications on clinical research and patient care of a population with, or at risk for, cardiotoxicity.
Keywords: Cardiovascular magnetic resonance, MUGA, Cancer, Ejection fraction, Onco-cardiology, Cardio-oncology Background Common cancer treatments such as anthracyclines and trastuzumab are associated with an increased risk of cardiotoxicity, which is responsible for significant mortality and morbidity in cancer survivors [ 1 , 2 ].
Assessment of left ventricular ejection fraction LVEF has been, and continues to be the most widely used method for cardiotoxicity risk assessment prior to, surveillance during, and surveillance after administration of potentially cardiotoxic cancer treatment [ 3 ]. Since the s [ 4 ], multiple gated acquisition scanning MUGA has been one of the first-line imaging modalities for baseline and serial assessment of LVEF for cardiotoxicity.
In addition to concerns about exposure to ionizing radiation, there is concern that contemporary gamma cameras may not allow optimal patient positioning for LVEF assessments [ 3 ]. Inaccurate LVEF assessment may carry significant implications for the care of cancer patients receiving potentially cardiotoxic treatment since LVEFs play an important role in decisions to start, continue, hold or stop such treatment. Patients were excluded if their records indicated any of these intervening clinical events that could potentially impact cardiac function: acute myocardial infarction, heart failure hospitalization, administration of potentially cardiotoxic cancer treatment, or acute systemic illness such as sepsis.
An electronic database was created to include demographic information, medical history including reasons for the studies, co-morbidities and medications, and MUGA and CMR findings for each patient. Louis, Missouri, USA was used. Acquisition times were adjusted to achieve a minimum of , counts per frame. Experienced nuclear medicine technologists performed LVEF analyses. Scintigrams were smoothed off-line using standard algorithms, and background correction was performed.
The LV regions of interest, as well as background activity, were selected automatically by the computer program E.The latter curve is then subtracted from the raw time-activity curve over the ED ROI resulting in a background-corrected LV time-activity curve. Continuous variables were expressed as means and standard deviations, or medians and inter-quartile ranges IQR for data that were not normally distributed. Myocardial imaging with Thallium a multicenter study in patients with angina pectoris or acute myocardial infarction. Additional approved, but less frequently requested, clinical indications for ERNA are assessment of global and regional LV function in patients with recent or old infarction, in patients with congestive heart failure, and in patients who are potential candidates for implantation of defibrillator.
A major leap forward was the work by Green et al 5 who explored LIST-mode rather than frame-mode computer acquisition.
Logistic regression was used to determine univariate predictors of misclassification. The scintillations were displayed on an oscilloscope and continuously exposed through open lens to photographic film or paper.
The ECG R-wave is the synchronizing trigger for starting and restarting multigated image acquisition sequences. Although exercise LV function testing had less diagnostic value for the detection of coronary artery disease than initially anticipated, peak exercise LVEF had important prognostic value in patients with variety of cardiac diseases. Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging.
References 1. Measurement of left ventricular ejection fraction. The opening of the gate was triggered at predetermined delays after the electrocardiographic R-wave during systole and diastole, respectively. The resulting gated planar images can be processed using standard planar ERNA analysis software. Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging. These data have significant implications on clinical research and patient care of a population with, or at risk for, cardiotoxicity.