Post-stress
Myocardial Stunning
Department of Nuclear Medicine
Seoul Nat’l Univ. College of Medicine
Jin Chul Paeng, MD
Patient
• 6-year-old male
• DOE with cardiac murmur
• FHx of sudden death (Grandfather and
father)
• Preexam Dx of Idiopat...
Protocol
STRESS
Tc-99m-MIBI
Dipyridamole Stress
0.56 mg/kg/4min
Gated SPECT
1st 2nd
Rest
Tc-99m-MIBI
Gated SPECT Next day
Surface Motion
Stress
Wall
Thickening
Rest
Wall
Thickening
Stress
Rest
Myocardial Stunning
• Classic Concept
– Myocardial dysfunction due to temporary
decreased perfusion
– Dependent on perfusi...
Acute Stunning
• Induced by acute stress
– Either physical or psychologic
– Variable duration
• Usually prolonged over fro...
Prolonged Stunning
• “Transient prolonged stunning induced
by dipyridamole and shown on 1- and 24-
hour poststress 99m
Tc-...
Summary
• Gated myocardial SPECT in patient with
IHSS showed decreased motion and
thickening at stress image while normal
...
Post-stress Myocardial Stunning Department of Nuclear Medicine
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Post-stress Myocardial Stunning Department of Nuclear Medicine

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Post-stress Myocardial Stunning Department of Nuclear Medicine

  1. 1. Post-stress Myocardial Stunning Department of Nuclear Medicine Seoul Nat’l Univ. College of Medicine Jin Chul Paeng, MD
  2. 2. Patient • 6-year-old male • DOE with cardiac murmur • FHx of sudden death (Grandfather and father) • Preexam Dx of Idiopathic Hypertrophic Subaortic Stenosis (IHSS) • Consulted for myocardial SPECT
  3. 3. Protocol STRESS Tc-99m-MIBI Dipyridamole Stress 0.56 mg/kg/4min Gated SPECT 1st 2nd Rest Tc-99m-MIBI Gated SPECT Next day
  4. 4. Surface Motion
  5. 5. Stress Wall Thickening Rest Wall Thickening
  6. 6. Stress Rest
  7. 7. Myocardial Stunning • Classic Concept – Myocardial dysfunction due to temporary decreased perfusion – Dependent on perfusion reserve • New Concept – Canty JM et al. JNC 2000;7:509-527 – Two kinds: acute / chronic (repetitive) – Preliminary state to ‘hibernation’ – A different phase on a continuum of coronary artery disease
  8. 8. Acute Stunning • Induced by acute stress – Either physical or psychologic – Variable duration • Usually prolonged over from several hours to a couple of days • How about on iatrogenic stress? – Exercise – Pharmacoloic • Inotropics • Vasodilators
  9. 9. Prolonged Stunning • “Transient prolonged stunning induced by dipyridamole and shown on 1- and 24- hour poststress 99m Tc-MIBI gated SPECT” – Lee DS et al. – JNM 2000;41:27-35 – One-hour poststress myocardial motion shows stunning effect, compared to wall motion at 24-hour after stress
  10. 10. Summary • Gated myocardial SPECT in patient with IHSS showed decreased motion and thickening at stress image while normal motion and thickening at rest. • It can be stunning effect of dipyridalmole stress.
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