(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