(Prepared by Dr Isabel Berrocal)

 

 

 

 

 

 

 

 

 

                                   

 

 

            61 year old male patient with history of PTCA in 2002 and 2006, underwent equilibrium radionuclide due to atypical chest pain. Study done with Tc 99m labeled red blood cells (“in vivo” tecnique) including  basal and sequential study protocol with dobutamine continuous infusion  intravenously increasing 5 ug every 3 minutes up to 40 ug / kg / min. Acquisition was performed getting planar images. Gating with 24 frames in best septal LAO. In the baseline study, we can see normal-sized ventricles, and good LV motility (posterolateral, septal and inferoapical wall), right ventricle motility is also normal. LVEF was 52% with automatic and manual methods. RVEF was 52% (Figures A and B).
            In the stress study, patient achieved 81% of maximal predicted heart rate, adding atropine in the final stage. Adequate motility persists in both ventricles, the left cavity has normal size and the overall systolic function improved, with LVEF of 65% and RVEF 58% manual methods (Figures C and D). The phase and amplitude analysis in OAI view was normal and did not show any abnormality in baseline and post-stress studies (not shown). In conclusion, the equilibrium ventriculography at rest and submaximal exercise was within normal limits.
            Planar equilibrium radionuclide angiocardiography includes evaluation of ventricular wall motion, ejection fraction (EF), and other parameters of systolic and diastolic function. This is a sensitive procedure used to determine global and regional  ventricular function at rest and/or during exercise or pharmacologic stress to evaluate significance of  abnormalities during the post-stress test. Also, it can be used to evaluate LV function in valvular insufficiency pre and post surgical intervention.

References:

1.-    Corbett J. et al. Equilibrium radionuclide angiocardiography. American Society of Nuclear Cardiology. Imaging guidelines for nuclear cardiology procedures. 2009.
2.-     Maceira AM. et al.Changes in the left ventricular function with growing doses of dobutamine in healthy individuals. Rev Esp Med Nucl. 1999 Jun;18(3):176-82
 

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