Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison

• Published in: Journal of cardiothoracic surgery 2017-10, Vol.12 (1), p.89-89, Article 89
• Main Authors: Avery, Ryan, Day, Kevin, Jokerst, Clinton, Kazui, Toshinobu, Krupinski, Elizabeth, Khalpey, Zain
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angiography; Angiography - methods; Automatic implantable cardiac device; Cardiology; Cardiomyopathy; Catheterization; Complications; Echocardiography; Evaluation; Feasibility studies; Female; First pass radionuclide angiography; Functional analysis; Heart; Heart diseases; Heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart rate; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Heart-Assist Devices; Hemodynamics; Humans; Intubation; Left ventricular ejection fraction; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Mathematical analysis; Medical imaging; Medical records; Middle Aged; Mortality; Multigated acquisition radionuclide angiography; NMR; Nuclear magnetic resonance; Parameter identification; Patients; Placement; Preoperative Period; Pulmonary arteries; Radioisotopes; Retrospective Studies; Right ventricular ejection fraction; Statistical analysis; Stroke Volume - physiology; Transplants & implants; Ventricle; Ventricular Function, Right - physiology; Ventriculography, First-Pass - methods
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-017-0652-y

Advanced heart failure treated with a left ventricular assist device is associated with a higher risk of right heart failure. Many advanced heart failures patients are treated with an ICD, a relative contraindication to MRI, prior to assist device placement. Given this limitation, left and right ventricular function for patients with an ICD is calculated using radionuclide angiography utilizing planar multigated acquisition (MUGA) and first pass radionuclide angiography (FPRNA), respectively. Given the availability of MRI protocols that can accommodate patients with ICDs, we have correlated the findings of ventricular functional analysis using radionuclide angiography to cardiac MRI, the reference standard for ventricle function calculation, to directly correlate calculated ejection fractions between these modalities, and to also assess agreement between available echocardiographic and hemodynamic parameters of right ventricular function. A retrospective review from January 2012 through May 2014 was performed to identify advanced heart failure patients who underwent both cardiac MRI and radionuclide angiography for ventricular functional analysis. Nine heart failure patients (8 men, 1 woman; mean age of 57.0 years) were identified. The average time between the cardiac MRI and radionuclide angiography exams was 38.9 days (range: 1 - 119 days). All patients undergoing cardiac MRI were scanned using an institutionally approved protocol for ICD with no device-related complications identified. A retrospective chart review of each patient for cardiomyopathy diagnosis, clinical follow-up, and echocardiogram and right heart catheterization performed during evaluation was also performed. The 9 patients demonstrated a mean left ventricular ejection fraction (LVEF) using cardiac MRI of 20.7% (12 - 40%). Mean LVEF using MUGA was 22.6% (12 - 49%). The mean right ventricular ejection fraction (RVEF) utilizing cardiac MRI was 28.3% (16 - 43%), and the mean RVEF calculated by FPRNA was 32.6% (9 - 56%). The mean discrepancy for LVEF between cardiac MRI and MUGA was 4.1% (0 - 9%), and correlation of calculated LVEF using cardiac MRI and MUGA demonstrated an R of 0.9. The mean discrepancy for RVEF between cardiac MRI and FPRNA was 12.0% (range: 2 - 24%) with a moderate correlation (R = 0.5). The increased discrepancies for RV analysis were statistically significant using an unpaired t-test (t = 3.19, p = 0.0061). Echocardiogram parameters of RV function, including TAPSE and