Purpose: Right ventricular ejection fraction (RVEF) is a strong predictor of adverse outcomes in patients with heart failure and LV dysfunction. RVEF can be calculated by first pass radionuclide ventriculography (FPRNA) as part of gated SPECT MPI, used for ischemia, scar, as well as for viability assessment. The aim of this study was to perform comprehensive assessment of LV and RV parameters, to examine the correlation of RVEF with LV perfusion and function variables and to predict cardiac death.
Methods: Patients with heart failure who were referred for gated SPECT underwent FPRNA by Tc 99m sestamibi prior to gated SPECT MPI. FPRNA was done by a dedicated cardiac system with a general purpose collimator while gated SPECT was done with high resolution collimator. Of the 144 patients, 124 patients with LVEF< 40% were studied. RVEF was correlated to LV variables: LVEF, LVEDV, LVESV, scar size, location of scar and phase analysis parameters .The patients were followed for cardiac death.
Results: Mean age was 67± 10, 91% men. Mean LVEF was 26%±8, mean RVEF 51%±12, infarct size (score 0-4), 3.0±1.8, NYHA class 2.4±0.7 and LV dyssynchrony by phase SD was 65±19. RV dysfunction (RVEF<40%) was demonstrated in 21 (17%) patients. RVEF demonstrated significant correlation with NYHA class, LVEF, LV EDV and ESV but there was no correlation with infarct size, septum scar, and LV dyssynchrony. During 285±157 days of follow up, there were 12 (9.7%) cardiac deaths. NYHA class was the only independent predictor of cardiac death (x² 14, p=0.003) while RVEF showed borderline significance (-0.44, p=0.07).
Conclusion: RVEF by FPRNA with gated SPECT in patients with LV dysfunction is feasible and can be done as one stop shop. RVEF was significantly correlated with LVEF, LVEDV, LVESV and might predict cardiac death in heart failure patients.
