Influence of Patient Position on Attenuation Artifacts Observed in D-SPECT Camera Myocardial Tomoscintigraphy

Study Overview
=================
Brief Summary
-----------------
The purpose is to compare percentages of myocardial segments showing attenuation in patients in forward tilted position (biker position) or 2 conventional positions (dorsal decubitus or semi sitting) at acquisition with D-SPECT camera in myocardial tomoscintigraphy. The hypothesis is that the percentage of myocardial segments with attenuation is significantly lower when acquisitions are made in forward tilted position (biker position). The secondary purpose is to restrict this analysis to 3 cardiac regions most subject to attenuation artifacts (anterior, apical and inferobasal regions).

Detailed Description
-----------------
Myocardial perfusion tomoscintigraphy is a very used technique for diagnosis and characterization of abnormalities of stress and rest myocardial perfusion (ischemia, infarction). A common problem is attenuation artifacts that are due to tissue interposition attenuating radiation from some cardiac regions. These artifacts originate activity decreasing and thus perfusion abnormalities potentially in all walls of left ventricle, especially the inferior wall in men (attenuation by sub-diaphragmatic organs) and the anterior wall in women (attenuation by mammary glands). These artifacts are observed in rest and stress acquisitions and can lead to a wrong diagnosis of infarction. Attenuation artifacts can be identified with analysis of contraction kinetics with gated-SPECT (normal kinetics and thus discordant with aspect of infarction). With D-SPECT camera some artifacts can be prevented with a 30-35° forward tilted position of acquisition. This position, also called biker position, can take cardiac area away from sub-diaphragmatic structures. It can also reduce the distance between heart and detection surface of camera and limit respiratory movements of thoracic wall. In this study, patients with abnormal results at stress myocardial perfusion tomoscintigraphy will undergo a rest tomoscintigraphy. Acquisition will be done in forward tilted position and in one of 2 other positions: dorsal decubitus or semi sitting.

Official Title
-----------------
Influence of Patient Position on Attenuation Artifacts Observed in D-SPECT Camera Myocardial Tomoscintigraphy

Conditions
-----------------
Attenuation Artifact, Myocardial Tomoscintigraphy, Patient Position

Intervention / Treatment
-----------------
* Procedure: Rest tomoscintigraphy in forward tilted
* Procedure: Rest tomoscintigraphy in semi sitting position
* Procedure: Rest tomoscintigraphy in dorsal decubitus position


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Affiliation to social security Signed informed consent Previous clinical examination authorizing patient to undergo tomoscintigraphy Patient with abnormal results of stress tomoscintigraphy and needing a rest tomoscintigraphy Patient with sinus and regular cardiac rhythm Patient with stable clinical status (without signs of unstable cardiac or coronary failure, without uncontrolled hypertension under treatment) Exclusion Criteria: Women of childbearing potential without effective contraception Evolutive pregnancy Breastfeeding patient Contraindication to tomoscintigraphy Patient with history of hypersensibility to tomography radiotracer STAMICIS® or one of components Patient in life-and-death emergency Patient with history of disorders possibly interfering with contractility Patient with normal results of stress tomoscintigraphy Person under legal protection or incapable to consent Person deprived of liberty by judicial or administrative decision

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: forward tilted<br>Patients with abnormal results at stress myocardial perfusion tomoscintigraphy will undergo a rest tomoscintigraphy. Acquisition will be done in forward tilted position | Procedure: Rest tomoscintigraphy in forward tilted<br>* Rest tomoscintigraphy in forward tilted position<br>Procedure: Rest tomoscintigraphy in semi sitting position<br>* Rest tomoscintigraphy in forward tilted position, followed by a second rest tomoscintigraphy in semi sitting position, after max 30 min<br>Procedure: Rest tomoscintigraphy in dorsal decubitus position<br>* Rest tomoscintigraphy in forward tilted position, followed by a second rest tomoscintigraphy in semi sitting position, after max 30 min<br>|
| Other: semi sitting<br>Patients with abnormal results at stress myocardial perfusion tomoscintigraphy will undergo a rest tomoscintigraphy. Acquisition will be done in semi sitting | Procedure: Rest tomoscintigraphy in forward tilted<br>* Rest tomoscintigraphy in forward tilted position<br>Procedure: Rest tomoscintigraphy in semi sitting position<br>* Rest tomoscintigraphy in forward tilted position, followed by a second rest tomoscintigraphy in semi sitting position, after max 30 min<br>|
| Other: dorsal decubitus<br>Patients with abnormal results at stress myocardial perfusion tomoscintigraphy will undergo a rest tomoscintigraphy. Acquisition will be done in dorsal decubitus | Procedure: Rest tomoscintigraphy in forward tilted<br>* Rest tomoscintigraphy in forward tilted position<br>Procedure: Rest tomoscintigraphy in dorsal decubitus position<br>* Rest tomoscintigraphy in forward tilted position, followed by a second rest tomoscintigraphy in semi sitting position, after max 30 min<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of myocardial segments classified with attenuation artifact | With infarction aspect but normal contraction kinetics in Gated-SPECT analysis. Left ventricle is divided in 17 segments according to American Heart Association. | day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of myocardial segments classified with attenuation artifact in anterior region |  | day 0 | 
| Percentage of myocardial segments classified with attenuation artifact in apical region |  | day 0 | 
| Percentage of myocardial segments classified with attenuation artifact in inferobasal region |  | day 0 |