Characteristics of regional myocardial stunning after exercise in gated myocardial SPECT.

BACKGROUND

A number of studies have demonstrated prolonged left ventricular (LV) global dysfunction after exercise-induced ischemia in gated myocardial single photon emission tomography (SPECT) as a manifestation of exercise-induced stunning. This study investigated the residual effects of exercise on postexercise LV regional function and its implications on the detection of stunning in gated SPECT.

METHODS AND RESULTS

Fifty-three subjects with known or suspected coronary artery disease and 10 control subjects underwent myocardial SPECT according to a same-day exercise-rest protocol. Both postexercise and resting images were gated and acquired 1 hour after injection of technetium 99m tetrofosmin. The LV global ejection fraction and segmental systolic wall thickening were quantitated with the use of an automatic program. Segmental perfusion was assessed semiquantitatively on summed nongated tomograms. Wall thickening index (WTI), the ratio of systolic wall thickening of a segment to that of a corresponding control segment, was significantly lower after exercise than at rest in the reversible defect (RD) segments (0.66 +/- 0.24 vs 0.78 +/- 0.24; P <.0001). In patients with exercise-induced ischemia, the difference in WTI between rest and after exercise was significantly greater in the RD segments, which represented ischemia, than in the non-RD segments. Postexercise WTIs were not different from the resting values in subjects with no perfusion abnormalities or who had fixed defects (infarction). Significant postexercise dysfunction was present in 44% of the RD segments, compared with 5% of the normal and 3% of the fixed defect segments. Postexercise segmental dysfunction was correlated with the segmental reversibility score, the difference in defect scores between exercise and rest images (n = 82, Spearman rank correlation coefficient = -0.78, P <.0001). Among 19 patients with ischemia, 9 (47%) exhibited concurrent segmental and global dysfunction, but segmental dysfunction persisted in the absence of global dysfunction in 4 additional patients (21%).

CONCLUSIONS

Significant postexercise LV regional dysfunction, consistent with the concept of stunning, occurs in the region of severe ischemia. The incidence and magnitude of regional stunning are determined by the severity of ischemia. For the detection of stunning in gated SPECT, LV regional dysfunction may be more sensitive than global dysfunction.