Accuracy of left ventricular ejection fraction determined by gated myocardial perfusion SPECT with Tl-201 and Tc-99m sestamibi: Comparison with first-pass radionuclide angiography

Background. We compared estimates of left ventricular ejection fraction (LVEF) assessed by gated single photon emission computed tomography (SPECT), using both technetium-99m sestamibi and thallium-201, with those obtained by first-pass radionuclide angiography (FPRNA) in patients with a broad spectrum of LVEF and perfusion abnormalities. Methods. Sixty-three patients were randomly selected to undergo a dual isotope gated SPECT study (rest Tl-201 followed by adenosine Tc-99m sestamibi scintigraphy). Studies were processed by use of the Cedars quantitative gated SPECT software. FPRNA was acquired during an intravenous bolus injection of Tc-99m sestamibi and processed with a commercially available software. Results. The estimates of LVEF were similar (P = NS) with Tl-201 gated SPECT (54% ± 15%), Tc-99m gated SPECT (54% ± 16%), and FPRNA (54% ± 12%). There was an excellent correlation between Tc-99m and Tl-201 gated SPECT (Pearson's r = 0.92, P < .0001). There were also good linear correlations between Tc-99m sestamibi gated SPECT and FPRNA (Pearson's r = 0.85, P < .0001), as well as between Tl-201 gated SPECT and FPRNA (Pearson's r = 0.84, P < .0001). In the 16 patients with LVEF < 50%, Tc-99m sestamibi gated SPECT and FPRNA (Pearson's r = 0.84, P < .0001) and Tl-201 gated SPECT and FPRNA (Pearson's r = 0.92, P < .0001) correlated well. Conclusion. LVEF can be accurately assessed by gated SPECT with either Tc-99m sestamibi or Tl-201 in properly selected patients with normal or depressed left ventricular function.