Reduction of the LVEF measured with gSPECT after 1-3 hours after physical exercise in CAD

Summary:

Aim: It has been shown that exercise may lead to the myocardial stunning with reduction of LVEF, persisting for some time despite recovery of perfusion. The aim of this study was to check whether the post-stress decrease of LVEF lasts as long as 3 h after exercise. Patients, methods: The study was performed in 46 patients with CAD and in 10 normals (NMS). All patients underwent myocardial gSPECT after ^99mTc-tetrofosmin injection at rest and during stress with 2-day protocol. SPECT was started 1h after tracer injection at rest (R) and twice: 1h (S1) and 3hs (S3) after injection at stress. LVEF was calculated by the method of Germano et al. Results: All LVEF values were significantly lower in CAD patients than in the control group. In NMS mean LVEF was at rest similar to those obtained 1 h and 3 h after stress injection (59.0 ± 4.1, 60.0 ± 5.9, 58.0 ± 4.6, respectively; p >0.05). A post-exercise decrease of LVEF was observed in 2 normal patients both at S1 and at S3. In CAD group LVEF values were lower at S1 than at R (50.8 ± 13.6 versus 49.3 ± 12.8; p <0.05) and at S3 were lower than at S1 (49.3 ± 12.8 versus 46.0 ± 12.2;p <0.001). A significant decrease of LVEF was found in 18/46 patients 1 h post stress and in 36/46 3 h post stress. In patients with reversible perfusion decrease, a significant correlation was found between post-exercise deterioration of perfusion and post-exercise LVEF reduction both at S1 (r = 0.744; p <0.02) and at S3 (r = 0.734; p <0.02). Stress induced decrease in LVEF correlated also with severity of perfusion abnormalities. Conclusions: In the majority of patients with CAD physical stress applied for diagnostic purposes results in an impairment of the LV function. A decrease of the LVEF is observed 1 h after exercise, but it increases in frequency and grows stronger during the next 2 h. The post-stress LVEF reduction is related to the severity of perfusion abnormalities. Patients with CAD who underwent diagnostic stress test should remain under observation during several hours after termination of exercise.

Zusammenfassung:

Das Ziel dieser Arbeit war zu prüfen, ob die Verminde-rung der LVAF die 1 Stunde nach der Belastung auftritt, 3 Stunden nach Stress erhalten bleibt. Patienten, Methode: 46 Patienten mit koronarer Herzkrankheit (KHK) und 10 Gesunde (NMS) wurden untersucht. In allen Fällen wurde die Myokard-gSPECT nach ^99mTcTetrofosmin-Injektion in Ruhe und unter Belastung durchgeführt. Die SPECT-Akquisition wurde 1 h nach Injektion in Ruhe und zweimal (1 h, 3 h) nach Injektion unter Belastung gestartet. Die LVAF wurde nach der Methode von Germano et al. berechnet. Ergebnisse: Die von allen drei Untersuchungen gewonnene LVAF-Werte waren bei KHK signifikant niedriger, als bei NMS. In NMS war die mittlere LVAF 1 h nach der Ruheinjektion ähnlich den beiden Werten nach Belastung (59.0 ± 4.1; 60.0 ± 5.9; 58.0 ± 4.6; p >0.05). Die KHK-Patienten zeigten eine Stunde nach dem Stress niedrigere LVAF-Werte als nach Ruheinjektion (50.8 ± 13.6 versus 49.3 ± 12.8; p <0.05). Eine stärker ausgeprägte LVAF-Senkung wurde 3 h nach Belastung gefunden. (49.3 ± 12.8 versus 46.0 ± 12.2; p <0.001). Die Reduktion der LVAF zeigte sich bei 18/46 Patienten 1 h und bei 36/46 Patienten 3 h nach Stress. Bei Patienten mit reversiblen Perfusionsdefekten wurde eine signifikante Korrelation zwischen stressinduzierter Perfusionsverschlechterung und LVAF-Senkung 1 h (r = 0.744; p<0.02) und 3 h (r = 0.734; p <0.02) nach Belastung festgestellt. Stressinduzierte Reduktion der LVAF korrelierte auch mit dem Ausmaß der Perfusionsstörung. Schlussfolgerungen: Belastung, die für die diagnostische Zwecke angewandt wurde, führte bei den meisten KHK-Patienten zu einer Verschlechterung der Herzfunktion. Die Reduktion der LVAF zeigt sich 1 h nach Belastung, verstärkt sich aber und wurde häufiger während der folgenden 2 h. Die AF-Senkung nach Belastung ist mit der Intensität der Perfusionsstörung verbunden. KHKPatienten, die einer Belastung unterzogen werden, sollen danach einige Stunden lang unter Kontrolle stehen.

Key words:

Myocardial stunning - LVEF - gatedSPECT

Schlüsselwörter:

Myokard-Stunning - Stunning - LVEF - gSPECT

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