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New Techniques and Applications P4 TUESDAY PROCEEDINGS OF THE 31ST ANNUAL MEETING TUESDAY, JUNE 5, 1984 measure EFs which correlate well with gamma camera measurements) was employed to record sequential 2 minute time activity curves from the left ventricles of 6 healthy men (ages 19-24) during a control period and during a 30 8:00-10:00 Petree Hall in the Los Angeles Convention Center minute stress interview with a psychiatrist. Four o£the subjects were also monitored in a cold room (1°C) for 20 min« In addition to the left ventricular time-activity FORMAL OPENING AND PLENARY SESSION curve, heart rate (HR), and BP (cuff) were recorded. All 8:15 WELCOME AND TRIBUTE TO THE FOUNDER'S subjects had increases in HR, BP and EF during the stress interview. Cold, however, produced decreases in HR and EF GROUP,* Merle K. Loken, M.D., Ph.D., and an increase in BP. The results (mean±Su)are tabulated below: President, Society of Nuclear Medicine HR BP EF Rest 66+ 2 121/80 ±13/4 51+11 REMARKS: B. Leonard Holman, M.D., Chairman, Sci Interview 76+11* 158/101+ 7/7* 68+13* Rest Pre-cold 70+ 7 114/76 +12/5 58+ 7 entific Program Committee 1984 Cold 63+ 4* 141/94 +14/5* 37+ 4* *p<.05 REMARKS: Shelley D. Hartnett, CNMT, President, End-systolic and end-diastolic counts and hence volume decreased during the interview and increased during cold Technologist Section exposure. These data suggest that (1) ambulatory changes in REMARKS: Thomas P. Haynie III, M.D., Chairman, ventricular function can be measured with the VEST, and (2) significant changes in cardiovascular physiology are seen Credentials and Membership Committee in normal subjects during a stress interview and exposure to cold. 8:30 THE FIFTH ANNUAL GEORG CHARLES DE HEVESY NUCLEAR MEDICINE PIONEER AWARD ESTIMATIONOF LEFTVENTRICULAREJECTIONFRACTIONBY COMPUT PRESENTATION honoring Henry N. Wagner, Jr., ERIZEDSINGLECARDIACPROBESYSTEMUITHECHOCARDIOGRAM. M.D., The Johns Hopkins Medical Institutions: Y. Suzuki,M. Ide,N. Kenemoto,H. Tomoda,andM. Nakamura TokaiUniversity,Schoolof Medicine,Isehara-city,Japan S. James Adelstein, M.D., Ph.D., Lecturer, Massa chusetts General Hospital. We developeda computerizedsinglecardiacprobesystem combinedwithechocardiogramwhichpermitsthe physicianto 9:00 First Annual SNM Lectureship: Imaging with positionthedetectormoreeasilyand properly. Withthis systemleftventricularejectionfraction(LVEF)can be es Radiolabeled Antibodies. Steven M. Larson, M.D., timatedby thethreedifferentmodes:firstpass(FP)mode, National Institutes of Health beat-by-beat(B-B)modeand ECGmultigated(MG)mode. In FP modecomplexdemodulationtechniqueis appliedforestimat ionof thebackgroundcounts. The purposeof thispaper 10:00 Opening of the 1984 SNM Exposition is to describetheaccuracyand reproducibilityof theLVEF estimatedby thissystem. In40 patientswithvarious heartdiseases,theLVEFsestimatedby thissystemusing above-mentioned3 modeswerecomparedwiththoseof obtain ed by gammacamera. Thereweregoodcorrelationsbetween theLVEFsestimatedby eachof the 3 modesof thissystem andobtainedby gammacamera. The correlationcoefficient (r)betweentheLVEFsestimatedby FP mode,B-Bmodeand MG mode,and thoseof by gammacamerawas 0.938,0.932,and 0.930,respectively.In 15 patientsFP modestudywas re peatedcontinuouslyand LVEFsobtainedin the initialand "The Founders' Group, as identified on the program of the First Annual repeatstudieswerecompared. Therewas qoodagreement Meeting of the Society of Nuclear Medicine, which took place May 29-30. betweentheseresults(r=0.953).In 12 patientsposition 1954, at the Benjamin Franklin Hotel in Seattle, WA, includes (in alphabetical ingof theprobeoverthe leftventricleandbackground order): A. Kearney Atkinson, M.D.; Thomas Cariile, M.D.; EggertT. Feldsted, areawas repeated5 timesand LVEFswereestimatedeach M.D.; William H. Hannah. B.S.; Milo Harris, M.D.; Norman J. Holler, M.A.; timeby B-Bmode. Therewas no significantstandarddevi Rex L. Huff, M.D.; Tyra T. Hutchens, M.D.; Robert G. Moffat, M.D.; Joseph ationcomparedto themeanLVEFsineachpatient;theper R. Nealen, S.J.; Asa Seeds. M.D.; and Charles P. Wilson, M.D. centcoefficientof variationwas lessthan8.0%. Incon clusion,our resultssuggestthatLVEFcan be estimated accuratelyby eachof the 3 modesof thissystemand repro ducibilityseemsto be sufficientforclinicalstudies. 10:30-12:00 Room 217A ETIOLOGY OF CARDIOGENIC SHOCK EARLY AFTER OPEN-HEART SUR GERY: ASSESSMENT BY Tc-99m RBC WALL MOTION SCINTIGRAPHY. T CARDIOVASCULAR I: Bateman, R Gray, A Chaux, M Lee, J Matloff, M Raymond, D VENTRICULAR FUNCTION- Herman. Cedars-Slnal Medical Center, Los Angeles, CA NEW TECHNIQUES AND APPLICATIONS When life-threatening cardiogenlc shock (CI 1.8 1/min/m , elevated right and left-side filling pressures) occurs early (0-48 hrs) after open-heart surgery, routine ap Moderator: H. William Strauss, M.D. proaches frequently cannot distinguish between expected Comoderator: Jonathan M. Links, Ph.D. etiologies: (1) transient systolic failure of the LV, RV, or both, common early postoperatively (postop); (2) perioperative infarct of the LV or RV; (3) myocardial CHANGES IN VENTRICULAR FUNCTION DURING EMOTIONAL STRESS AND restriction due to active pericardial bleeding or to ac COLD EXPOSURE. M.C. Kiess, R.A. Moore. J. Dimsdale. N.M. cumulated clots and fluid; (4) diminished LV reserve from Alpert, C.A. Boucher, H.W. Strauss. Massachusetts General aneurysraectomy; and (5) residual valvular régurgitation. Hospital» Boston* MA. Distinction Is critical, because (1), (2), and (4) will be treated by optimizing preload and afterload; (3) with ur Patients with cardiac disease freqently develop symptoms gent (if active bleeding) or semi-urgent surgery; and (5) with emotional stress or cold exposure. To investigate the with repeat valvular surgery. In 22 pts with unexpected effects of these stresses in normal subjects» an ambulatory early postop cardiogenic shock, Tc-99m-RBC equilibrium ventricular function monitor (VEST) (previously reported to radionuclide ventrlculography revealed: global LV (3 pts) P4 THE JOURNAL OF NUCLEAR MEDICINE PROCEEDINGS OF THE 31ST ANNUAL MEETING TUESDAY or RV (3 pts) dysfunction, new segmentalLV dysfunction(2 An integratedtechniquefor Fourier analysis in multi- pts), active bleeding (5 pts) and/or accumulatedperlcar- gated blood pool ECT study has been developed. Following dial fluid (8 pts) with hyperdynamicLV and RV, and a small the administrationof 15-20 mCi of Tc-99m RBC, ECG-gated hyperdynamic LV without effusion (1 pt), providing a cardiac blood pool data were acquired using an ECT system specific etiologicdiagnosisin all cases. In our Cardiac with dual opposed gamma cameras. Fundamentalstudies for Surgical 1CU, therapeutic decisions frequentlyawait and data acquisitionshowed that acquisitiontime of 10 sec. depend on the results of equilibrium radionuclide for each projection,14 divisionsof one cardiac cycle and ventrlculography,now routinely performed in postop pts angular intervalof 6°(60projectionsover 360°)were with unexpectedcardiogenicshock. reasonablefor clinicalpurpose. Total acquisitiontime was about 5 minutes under these conditions. Data were processedas follows. 1) Transaxial (TA) A METHOD TO IDENTIFYEARLY VENTRICULARDYSFUNCTIONUSING tomographicimages in every phase of cardiac cycle were RESTING GATED BLOOD POOL SCANS (GBPS) IN PATIENTS WITH reconstructedby convolutionalgorithm. 2) TA images were rotated to constructsagittal (SAG)and short axial (S-A) CORONARY ARTERY DISEASE (CAD). R.J. Schwarzberg,D.W. oblique-angletomographywhich are respectivelyparallel Seidin, L.L. Johnson, P.O. Alderson. ColumbiaUniversity, NY. and perpendicularto the long axis of either of the ventri cles. 3) Images coveringthe portion other than the To determine the sensitivityof regional 1st and 2nd purposedventriclewere eliminatedfrom the series of SAG images in every phase of the cycle. 4) Images in the same time derivative (1DV, 2DV) images to assess ventricular phase were summed to constructa series of SAG and S-A function (VF) in CAD, the resting GBPS of 8 normal patients (pts) and 20 pts with CAD who had coronaryangiographyand planar images. 5) Fourier analysiswas made to construct contrastventriculography(CV) were analyzed. The 1DV and phase and amplitudeimages. 2DV of the systolic time-activitycurve were determinedfor The advantagesof this method are that the phase and amplitudeimages from arbitrarydirectionscan be obtained, each left ventricularpixel in the GBPS. These values were displayedas functionalimages that were reviewed by three that the region of interestcan be selectedon a three dimensionalbasis, eliminatingthe overlappingactivity of readers to determine the presence of regional abnormali the other ventricleor neighbouringtissues, that the ties. No regional abnormalitieswere seen in the conven diseasedareas can be easily and accuratelylocalizedeven tional GBPS or 1DV or 2DV images of the 8 normal pts. Re in small inferiorwall myocardialinfarctionand that gional GBPS and DV image abnormalitieswere seen in all 10 patient study can be finishedwithin 5 minutes. pts with CAD and abnormal wall motion by CV. The DV image abnormalitieswere in the distributionof 18/22 coronary arteries (CA) withJ50% stenoses;2 of these regions showed normal wall motion by CV and conventionalGBPS. DV images 10:30-12:00 were abnormal in 2/8 CAs without significantstenoses. In Room 216BC addition,regional DV image abnormalitieswere present in 9of 10 pts with CAD who had normal wall motion and global ejection fractionby both CV and resting GBPS. These 10 INSTRUMENTATION I: pts showed regional abnormalitiesin
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