Nuclear Cardiology Principles and Methods Topics in Cardiovascular Disease Series Editors: Edmund Sonnenblick Albert Einstein School of Medicine, New York and William W. Parmley University of California Medical School, San Francisco NUCLEAR CARDIOLOGY: Principles and Methods Edited by Aldo N. Serafmi, Albert J. Gilson, and William M. Smoak. 1976 Nuclear Cardiology Principles and Methods Edited by Aldo N. Serafini, Albert 1. Gilson, and William M. Smoak Mount Sinai Medical Center and University of Miami School of Medicine Miami, Florida Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data Main entry under title: Nuclear cardiology. (Topics in cardiovascular disease) lncludes bibliographical references and index. 1. Cardiovascular system-Diseases-Diagnosis. 2. Radioisotopes in cardiology. 3. Radioisotope scanning. 1. Serafini, Aldo N. II. Gilson, Albert J. III. Smoak, William M. IV. Series [DNLM: 1. Radioisotopes-Diagnostic use. 2. Heart diseases-Diagnosis. 3. Heart diseases-Physiopathology. WG141 C641) WG141 C641j RC669.C53 616.1'07'575 76-39783 ISBN 978-1-4684-2276-4 ISBN 978-1-4684-2274-0 (eBook) DOI 10.1007/978-1-4684-2274-0 © 1977 Springer Science+Business Media New York Originally published by Plenum Publishing Corporation in 1977 Softcover reprint of the hardcover 1s t edition 1977 AII rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors Naomi P. Alazraki, Departments of Radiology and Medieine, University of Califomia, Medieal Center, San Diego, Califomia David R. ADen, Department of Cardiology and Nuclear Medicine, Veterans Administration Hospi tal, Seattle, Washington William L. Ashburn, Division of Nuclear Medicine, Department of Radiology, University of Califomia Medical Center, San Diego, Califomia Fuad S. Ashkar, Department of Radiology, University of Miami School of Medieine, Jaekson Memorial Hospital, Miami, Florida Frederick J. Bonte, Department of Radiology, Southwestem Medieal Sehool, The University of Texas Health Scienee Center, Dallas, Texas Gary Broek, Departments of Radiology and Medieine, University of Califomia Medical Center, San Diego, Califomia L. Maximilian Buja, Department of Pathology, Southwestem Medical Sehool, The University of Texas Health Seienee Center, Dallas, Texas George C. Curry, Department of Radiology, Southwestem Medical Sehool, The University of Texas Health Science Center, Dallas, Texas James H. Ellis, Jr., Department ofMedicine, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado Milton T. English, Department of Cardiology and Nuclear Medieine, Veterans Administration Hospital, Seattle, Washington RonaId D. Finn, Department of Radiology, Baumritter Institute of Nuclear Medieine, Mount Sinai Medieal Center, Miami Beaeh, Florida Albert J. Gilson, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medieal Center, Miami Beaeh, FIorida K. Lanee Gould, Department of Cardiology and Nuclear Medicine, Veterans Administration Hos pital, Seattle, Washington J. J. Greenberg, Department of Thoraeie Surgery, University of Miami School of Medicine, Mount Sinai Medical Center, Miami Beach, Florida Gien W. Hamilton, Nuclear Medicine and Cardiology Services and Department of Cardiology and Nuclear Medieine, Veterans Administration Hospital, Seattle, Washington Hartrnut Henning, Departments of Radiology and Medicine, University of Califomia Medieal Center, San Diego, Califomia v vi Contributors Frank J. Hildner, Department of Medicine, University of Miami School of Medicine, Miami, Florida; and Department of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida J. E. Holden, Department of Radiology, University of Wisconsin Medical School, Madison, Wis consin Homer B. Hupf, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida Warren R. Janowitz, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida Michael Jenkins, Departments of Medicine and Surgery, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado Allen D. Johnson, Departments ofRadiology and Medicine, University of California Medical Center, San Diego, California J. Ward Kennedy, Nuclear Medicine and Cardiol'ogy Services and Veterans Administration Hospital, Seattle, Washington P. J. Kenny, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida Dennis Kirch, Departments of Medicine and Surgery, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado A. J. Kiuru, Department of Radiology, University of Wisconsin Medical School, Madison, Wiscon sin Gerry Maddoux, Departments of Medicine and Surgery, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado P. J. Nelson, Department of Radiology, University of Wisconsin Medical School, Madison, Wis consin R. J. NickIes, Department of Radiology, University of Wisconsin Medical School, Madison, Wis consin George Pappas, Departments of Medicine and Surgery, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado Robert W. Parkey, Department of Radiology, Southwestern Medical School, The University of Texas Health Science Center, Dallas, Texas R. E. Polcyn, Department of Radiology, University of Wisconsin Medical School, Madison, Wis consin James L. Ritchie, Department of Cardiology and Nuclear Medicine, Veterans Administration Hospital, Seattle, Washington R. R. Sankey, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida Heinrich R. Schelbert, Departments of Radiology and Medicine, University of California Medical Center, San Diego, California Aldo N. Serafini, Department of Radiology, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida William M. Smoak, III, Department of Radiology, University of Miami School of Medicine, Baumritter Institute of Nuclear Medicine, Mount Sinai Medical Center, Miami Beach, Florida Peter P. Steele, Department of Medicine, Denver Veterans Administration Hospital, University of Colorado Medical Center, Denver, Colorado Ernest M. Stokely, Department of Radiology, Southwestern Medical School, University of Texas Health Science Center, Dallas, Texas Contributors vii D. M. Tamer, Department ofPediatrics, University of Miami School ofMedicine, Jackson Memorial Hospital, Miami, Florida Jobn W. Verba, Departments of Radiology and Medicine, University of California Medical Center, San Diego, California Manuel Viamonte, Jr., Department of Radiology, University of Miami School of Medicine, and Mount Sinai Medical Center, Miami Beach, Florida Maria Viamonte, Department of Pathology, University of Miami School of Medicine, and Mount Sinai Medical Center, Miami Beach, Florida Denny D. Watson, Department of Radiology, Baumritter Institute of Nuc1ear Medicine, Mount Sinai Medical Center, Miami Beach, Florida James T. Willerson, Department of Medicine, Southwestern Medical School, The University of Texas Health Science Center, Dallas, Texas Barry L. Zaret, Departments of Internal Medicine and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut Foreword Nuclear medicine is undergoing major orientation both praetieally and eoneeptu ally. To this point nuclear medieine has direeted the major portion of its effort to visualization of statie organ systems. The true value of this teehnique lies not in its ability to graphieally display organ systems, but rather its ability to measure organ funetion in a noninvasive manner. Dr. Serafini and his eolleagues have, in this book, brought together the experts of the different phases of cardiodynamies. The eontents lead one to believe that there are relatively simple innoeuous tests that ean supply large amounts of extremely important physiologie data without the neeessity for open invasion of the heart. Perhaps the most exciting part of the studies is the glimpse into the future they provide. The depth and versatility of these teehniques is displayed by the surprising variety of problems amenable to nuclear medieine examination. Perhaps the one point that is ever present in all these teehniques is the ability to perform the tests sequentially in different time frames as the patient's eondi tion ehanges or a major event is taking plaee, sueh as surgery. The work presented in this volume must be eonsidered the genesis of the new nuc1ear medieine and I, for one, look forward with great anticipation to what will follow. Albert J. Gilson ix Preface Recent advances in nuclear medicine have resulted in the development of a new field-nuclear cardiology. Because of new radiopharrnaceuticals, new types of equipment, and improved techniques, a new dimension to the evaluation of the cardiac patient is being provided to the armamentarium of the practicing clini cian. The rapid advances being made are a result of a multidisciplinary approach, with specialists from various fields contributing. This cooperation and teamwork is evident from the backgrounds of the various contributors in this book. The majority of the chapters in this volume describe nuclear cardiac techniques that can be safely and rapidly performed. As such, they have a great potential of providing a noninvasive method of evaluating the cardiac status of patients in whom cardiac disease is suspected. They will play an important complementary role to currently available diagnostic tests in the screening and staging of cardiac disease as weIl as provide an easily repeatable method of foIlow-up on ce therapy has been initiated, whether this is surgical or medical. It is hoped that this book will stimulate and promote further research and investigation in this dynamic new field and further improve our clinical techniques to the benefit of the cardiovascu lar patient. Aldo Serafini xi Contents Part I Fundamentals Basic Anatomy of the Normal and Diseased Heart . . . • • . • • . . . . • • . . 3 Manuel Viamonte, Jr. and Maria Viamonte Assessment of Left Ventricular Function: Current Methods and Clinical Significance .. . . • . • • . • . • • . . . . . • . • . . . . . . . . . . . . • . . . . . . . . IS GIen W. Hamilton and J. Ward Kennedy Radiopharmaceuticals for Cardiovascular Investigations • . • • . . . . . • • 27 Homer B. Hupf and Ronald D. Finn Part 11 Shunt Detection in Congenital Heart Disease Scintiangiographic and Probe Systems in the Detection of Cardiac Shunts. . . . . . . . • . . . . . . . . . . . . . . • . • . • • . . • • . • . • . • • • • • • . . . . . • . . • . 39 William L. Ashburn Detection of Left-to-Right Shunts by Inhalation of Oxygen-1S-Labeled Carbon Dioxide . . • . • . . . • . . . . . . . . . . . • • • . • . . . • . . . . • . • . • . . . . . . • . 49 D. D. Watson, P. J. Kenny, W. R. Janowitz, D. M. Tanner, and A. J. Gilson Part 111 Evaluation of Myocardial Blood Flow and Disease Myocardial Energetics .....•.............. . . . . . . . . . . . . • . . • . . . . 67 Frank J. Hildner xiii