Inter-institution preference-based variability of ejection fraction and volumes using quantitative gated SPECT with Tc-99m tetrofosmin : A multi-center study involving 106 hospitals

Purpose Inter-institution reproducibility of gated SPECT quantification based on institutional preferences was evaluated. This sort of variability is crucial for a multicentre study when many hospitals are involved. Methods A total of 106 institutes participated in this study and were grouped according to their use of five workstation types. Fifteen sets of 99mTc-tetrofosmin gated projection images with normal ejection fraction (EF) (70%, group A, n=5), borderline low EF (50%, group B, n=5) and low EF with large perfusion defects (30%, group C, n=5) were prepared. The projection images were processed by QGS software in each institute based on its own routine settings. Based on 318 QGS results, the reproducibility of EF and volumes was analysed for each group and workstation. Results The reproducibility of EF was good in 14 of 15 cases, showing a standard deviation (SD) of <3.6%, and the coefficient of variance of the end-diastolic volume (EDV) was <9.3% in all cases. When the deviation from the average value was analysed, the difference between EF at each institute and the average EF of the workstation (dEF) showed an SD of 2.2–3.7% for each group. The ratio of the EDV divided by the average EDV (rEDV) showed an SD of 0.061–0.069 for each group. One case in group C that had a large anterior defect with low EF showed bimodal EF distribution in one of the five workstations. The SD of EF was workstation dependent, owing to the SPECT reconstruction conditions. Conclusion The reproducibility in EF and volumes within a workstation was good, even though the gated SPECT preferences varied. This reproducibility study supports the use of gated SPECT as a standard of ventricular function in multicentre studies.© Springer-Verlag 1999

Prediction of Cardiac Mortality and Events by Myocardial Perfusion Imaging: Differences between Japanese and American Populations

金沢大學医薬保健研究域医学系Cardiac diseases are one of the major causes of death both in Western countries and in Japan. Based on various clinical information, identification of myocardial ischemia and contractile function plays a major role in predicting serious cardiac events of death and acute coronary syndromes. Currently, myocardial perfusion imaging provides both kinds of information, and clinical follow-up studies have been performed in the U.S., Europe and Japan. Due to our involvement in a Japanese multi-center prognostic study, we have found similarities and differences between Western and Japanese populations. The most important predictors of cardiac events are myocardial perfusion abnormality and ventricular function. The importance of diabetes and chronic kidney disease should be also emphasized. The trends of cardiovascular events should be carefully investigated because of westernized diets and lifestyles in addition to current progress of therapeutic strategy

Prognostic table for predicting major cardiac events based on J-ACCESS investigation

金沢大学医薬保健研究域医学