Comparison of technetium-99m sestamibi-gated tomographic perfusion imaging with echocardiography and electrocardiography for determination of left ventricular mass

Left ventricular (LV) mass estimates obtained from post-stress gated single-photon emission computed tomographic (SPECT) perfusion images were compared with 2-dimensionally targeted M-mode echocardiograms and with resting electrocardiographic voltage in 32 patients with stress perfusion scans that were either normal or only mildly abnormal. Myocardial pixel volumes were obtained from SPECT transaxial slices at end-diastole, end-systole, and summed (“ungated”) static reformatted SPECT images at 2 levels of background subtraction, 37.5% and 35% of peak myocardial activity. The S-wave amplitude in lead V1 and the R-wave amplitude in V5 were summed for an electrocardiographic index of voltage. Echocardiographic LV mass was calculated using the modified Penn convention formula. SPECT myocardial mass estimates were significantly greater at diastole when compared with systolic or summed images. There was a moderate, although highly significant, correlation between echocardiographic and SPECT indexes of LV mass with the lower (35%) background threshold (r = 0.59, 0.60, and 0.53 for diastole, summed, and systole, each p < 0.001). The diastolic SPECT estimate of LV mass correlation with electrocardiographic voltage (r = 0.56) was superior to the correlation between echocardiography and electrocardiography (r = 0.30). With use of published criteria for the presence of LV hypertrophy on echocardiography, diastolic and systolic gated SPECT predicted echocardiographic results with 78% accuracy.