Equilibrium radionuclide angiocardiography: Its usefulness in current practice and potential future applications

Table 1 Older and recent applications of multigated acquisition

	Older applications	Recent applications	Evolving applications for routine use	Commonly employed modality in current practice
Chamber orientation	+	+/-	-	Echocardiogram
Chamber size	+	+/-	-	Echocardiogram
Rhythm abnormalities	+	-	-	Electrophysiologic studies
Global EF	++	++		Contrast angiogram, 2D echocardiogram
Regional EF	++	++		MUGA
Wall motion abnormalities	++	+/-	-	Gated myocardial perfusion scans
Diastolic function evaluation	-	+	++	Echo-Doppler with E/A measurements
Assessment of synchrony	-	-	++	Speckle tracking echocardiogram

EF: Ejection fraction; E/A wave: E wave depicts early [passive filling of left ventricular (LV)] and A wave represents active (atrial) filling of LV. Normally E>A. However, E<A is seen in diastolic dysfunction. ++: Strongly indicated; +: Indicated; +/-: Doubtful indication; -: Not indicated.

Table 2 Guidelines to perform multigated acquisition in adult patients on doxorubicin[14]

Baseline MUGA (before starting of chemotherapy or before 100 mg/m2 dose	If LVEF is ≤ 30% - no doxorubicin
If baseline LVEF is > 30% and < 50%	MUGA to perform before each dose
If baseline LVEF is ≥ 50%	MUGA to perform at the dose of 250-300 mg/m2, 400-450 mg/m2 and thereafter before each higher dose
If the fall of LVEF from previous study is ≥ 10% or if LVEF is ≤ 30%	Discontinue doxorubicin

MUGA: Multigated acquisition; LVEF: Left ventricular ejection fraction.

Table 3 Guidelines for serial monitoring of left ventricular ejection fraction in pediatric patients receiving anthracyclines and mediastinal irradiation[15]

If mediastinal irradiation is < 1000 cGy	Perform echocardiogram every alternate dose of doxorubicin when dose is < 300 mg/m2 and perform echocardiogram before each dose if the dose of chemotherapeutic agent is ≥ 300 mg/m2
If mediastinal irradiation is > 1000 cGy	Perform echocardiogram before each dose
When the cumulative dose of chemotherapy crosses 400 mg/m2	Perform MUGA before any additional dose
Discontinue doxorubicin	If the fall of LVEF is ≥ 10% from previous study or LVEF is < 55%
Follow up	MUGA at 1st year of completion of therapy and then echocardiogram yearly till next 3 years and a repeat MUGA at 5th year along with electrocardiogram yearly

MUGA: Multigated acquisition; LVEF: Left ventricular ejection fraction.