Interventional Agents in Stress Myocardial Perfusion Imaging
Post-stress Myocardial Stunning Department of Nuclear Medicine
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Transcript of Post-stress Myocardial Stunning Department of Nuclear Medicine
Post-stress Myocardial Stunning
Department of Nuclear Medicine
Seoul Nat’l Univ. College of Medicine
Jin Chul Paeng, MD
Patient
• 6-year-old male
• DOE with cardiac murmur
• FHx of sudden death (Grandfather and father)
• Preexam Dx of Idiopathic Hypertrophic Subaortic Stenosis (IHSS)
• Consulted for myocardial SPECT
Protocol
STRESS
Tc-99m-MIBI
Dipyridamole Stress0.56 mg/kg/4min
Gated SPECT
1st 2nd
Rest
Tc-99m-MIBI
Gated SPECT Next day
Surface Motion
Stress
Wall
Thickening
Rest
Wall
Thickening
Stress
Rest
Myocardial Stunning
• Classic Concept– Myocardial dysfunction due to temporary d
ecreased perfusion
– Dependent on perfusion reserve
• New Concept – Canty JM et al. JNC 2000;7:509-527
– Two kinds: acute / chronic (repetitive)
– Preliminary state to ‘hibernation’
– A different phase on a continuum of coronary artery disease
Acute Stunning
• Induced by acute stress– Either physical or psychologic
– Variable duration• Usually prolonged over from several hours to a
couple of days
• How about on iatrogenic stress?– Exercise
– Pharmacoloic• Inotropics
• Vasodilators
Prolonged Stunning
• “Transient prolonged stunning induced by dipyridamole and shown on 1- and 24-hour poststress 99mTc-MIBI gated SPECT”– Lee DS et al.
– JNM 2000;41:27-35
– One-hour poststress myocardial motion shows stunning effect, compared to wall motion at 24-hour after stress
Summary
• Gated myocardial SPECT in patient with IHSS showed decreased motion and thickening at stress image while normal motion and thickening at rest.
• It can be stunning effect of dipyridalmole stress.