Poststress Measurements of Left Ventricular Function with Gated Perfusion SPECT: Comparison with Resting Measurements by Using a Same-Day Perfusion-Function Protocol

PURPOSE: To investigate the relationship between the development of ischemia during stress testing and the changes in left ventricular ejection fraction (LVEF) measurements obtained after stress and at rest with a same-day perfusion-function imaging protocol.

MATERIALS AND METHODS: One hundred twenty-six patients underwent a same-day rest-stress (61%) or stress-rest (39%) protocol and gated single photon emission computed tomography (SPECT). Perfusion analysis was performed with a 12-segment model. Defects were scored (0 = no defect, 1 = mild defect, 2 = moderate defect, and 3 = severe defect); differences between the summed stress and resting scores of greater than three indicated substantial ischemia.

RESULTS: Resting and poststress LVEFs correlated significantly (r = 0.97, P < .001); however, patients with and patients without ischemia had significant differences in poststress versus resting LVEFs (−4.0 vs 1.0, respectively; P < .01). In patients with ischemia versus patients without ischemia, subgroup analysis stress-rest (−2.5 vs 1.0, P = .047) and rest-stress (−4.0 vs 1.0, P = .006) protocols yielded similar results.

CONCLUSION: In patients with clinically important stress-induced perfusion abnormalities, the LVEF after stress was significantly lower than the LVEF at rest with same-day rest-stress and stress-rest imaging protocols. In the clinical setting, poststress LVEFs may be lower than true resting measurements, particularly in patients with moderate to severe stress-induced ischemia.


  • 1 Borges-Neto S, Coleman RE, Jones RH. Perfusion and function at rest and treadmill exercise using technetium-99m sestamibi: comparison of one- and two-day protocols in normal volunteers. J Nucl Med 1990; 31:1128-1132.
  • 2 Jones RH, Borges-Neto S, Potts JM. Simultaneous measurement of myocardial perfusion and ventricular function during exercise from a single injection of technetium-99m sestamibi in patients with coronary artery disease. Am J Cardiol 1990; 66:68E-71E.
  • 3 Friedman JD, Berman DS, Kiat H, et al. Rest and exercise treadmill first-pass radionuclide ventriculography: validation of left ventricular ejection fraction measurements. J Nucl Cardiol 1994; 1:382-388.
  • 4 Borges-Neto S, Coleman RE, Potts JM, Jones RH. Combined treadmill exercise radionuclide angiography and SPECT perfusion studies for assessment of coronary artery disease. Semin Nucl Med 1991; 21:223-229.
  • 5 Borges-Neto S, Shaw L, Kesler KL, et al. Prediction of severe coronary artery disease by combined rest and exercise radionuclide angiocardiography and tomographic perfusion imaging with technetium 99m–labeled sestamibi: a comparison with clinical and electrocardiographic data. J Nucl Cardiol 1997; 4:189-194.
  • 6 Borges-Neto S, Shaw LK, Javaid A. Prediction of cardiovascular death and non-fatal myocardial infarction in patients with angiographically documented coronary artery disease: a comparison between clinical, stress test, perfusion and functional data. Circulation 1998; 98(suppl):I654.
  • 7 Borges-Neto S, Shaw LK, Coleman RE. Prediction of death and non-fatal myocardial infarction by combined perfusion and radionuclide ventricular function studies during pharmacologic stress testing. J Am Coll Cardiol 1999; 33(suppl):470A.
  • 8 Nichols K, DePuey EG, Rozanski A. Automation of gated tomographic left ventricular ejection fraction. J Nucl Cardiol 1996; 3:475-482.
  • 9 Germano G, Kiat H, Kavanagh PB, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995; 36:2138-2147.
  • 10 Chua T, Kiat H, Germano G, et al. Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, post-exercise regional ventricular function and myocardial viability: correlation with echocardiography and rest thallium-201 scintigraphy. J Am Coll Cardiol 1994; 23:1107-1114.
  • 11 Johnson LL, Verdesca SA, Aude WY, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress sestamibi tomograms. J Am Coll Cardiol 1997; 30:1641-1648.
  • 12 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1:307-310.
  • 13 Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 1995; 346:1085-1087.
  • 14 Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143:29-36.
  • 15 Di Leo C, Bestetti A, Tagliabue L, et al. 99m Tc-tetrofosmin gated-SPECT LVEF: correlation with echocardiography and contrastographic ventriculography. J Nucl Cardiol 1997; 4(suppl):S56.
  • 16 Rozanski A, Elkayam U, Berman DS, Diamond GA, Prause J, Swan HJC. Improvement of resting myocardial asynergy with cessation of upright bicycle exercise. Circulation 1983; 67:529-535.
  • 17 Rozanski A, Berman D, Gray R, et al. Preoperative prediction of reversible myocardial asynergy by postexercise radionuclide ventriculography. N Engl J Med 1982; 307:212-216.
  • 18 Ambrosio G, Betocchi S, Pace L, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina: evidence of myocardial stunning in patients with coronary artery disease. Circulation 1996; 94:2455-2463.
  • 19 Robertson S, Geigenbaum H, Armstrong WF, Dillon JC, O'Donnell J, McHenry PW. Exercise echocardiography: a clinically practical addition in the evaluation of coronary artery disease. J Am Coll Cardiol 1983; 2:1085-1091.
  • 20 Kata A, Force T, Folland E, Aebischer N, Sharma S, Parisi A. Echocardiographic assessment of ventricular systolic function. In: Marcus ML, Braunwald E, eds. Marcus cardiac imaging: a comparison to Braunwald's heart disease. Philadelphia, Pa: Saunders, 1996; 297-324.
  • 21 Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in dogs. J Clin Invest 1975; 56:978-985.
  • 22 Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982; 66:1146-1149.
  • 23 Kloner RA, Allen J, Cox TA, Zheng Y, Ruiz CE. Stunned left ventricular myocardium after exercise treadmill testing in coronary artery disease. Am J Cardiol 1991; 68:329-334.
  • 24 Dilsizian V, Bonow RO. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation 1993; 87:1-20.
  • 25 Vanoverscheld JL, Wikns W, Depre C, et al. Mechanism of chronic regional postischemic dysfunction in humans. Circulation 1993; 87:1513-1523.

Article History

Published in print: May 2000