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Left ventricular ejection fraction (LVEF) is the most widely used and easily available index of LV function. Almost all patients with suspected or documented heart disease undergo LVEF assessment at some point. There are nowadays, many different, invasive and non-invasive techniques for measuring LVEF including contrast ventriculography, echocardiography, magnetic resonance imaging (MR), computed tomography angiography (CT), and nuclear techniques. The nuclear techniques include the equilibrium radionuclide angiography (ERNA) referred to also as multigated angiography (MUGA), first-pass radionuclide ventriculography, gated single-photon computed tomography (SPECT) with myocardial perfusion imaging, and SPECT ERNA. Until the 1970s, the most commonly employed method of determining LV volumes and EF was LV contrast angiography performed at the time of cardiac catheterization. In 1971, Strauss et al described a new revolutionary ‘‘scintiphotographic method for measuring LVEF in man without cardiac catheterization.’’ As reported by Ashburn et al in the Seminars in Nuclear Medicine in 1973, this procedure made it possible to have multiple determinations of LVEF and volumes without additional administrations of radioactivity, allowing acquisition in different projections to evaluate wall motion of the various surfaces of the heart. Our knowledge of the physiological changes of LV function during exercise was enhanced from the application of ERNA. The introduction of computers further improved the potential widespread use of this technique, preparing the grounds for semi-automated measurement of LV function. It is of historical interest to know that these results were obtained by acquiring data on 12 K, 16 bits minicomputer system, recorded on magnetic tape and transferred them to a ‘‘large-scale digital computer as powerful as 200 k, 32 bits’’! In 1977, Borer et al demonstrated the feasibility of continuous monitoring and analysis of LV function during exercise allowing an accurate assessment of the presence and functional severity of ischemic heart disease. Global and regional dysfunction during exercise could easily be documented by ERNA. Specific features of ERNA were countbased measurement of LVEF independent from geometrical assumption and high reproducibility. Van Royen et al compared side by side echocardiographic and quantitative radionuclide LVEF: their conclusion was that LVEF determined by ERNA and echocardiography showed good agreement. Both methods provided clinically valuable measurements of LV function. However, when a precision was required for reproducible measurements, ERNA was the method of choice. Checking on PubMed with the following search terms, ‘‘radionuclide ventriculography,’’ Radionuclide angiography,’’ ‘‘ERNA,’’ ‘‘MUGA,’’ ‘‘scintigraphic angiocardiography,’’ ‘‘radionuclide cineangiography,’’ ‘‘scintiphotographic,’’ ‘‘gated scintiphotography,’’ ‘‘radio isotopic angiocardiography,’’ ‘‘radionuclide angiocardiography,’’ or ‘‘ejection fraction,’’ we found 2591 published papers on this topic. The use of ERNA reached its highest peak in the decade 1985-1995 (Figure 1), with a slow but progressive decline since. The main reason for this decline is most likely the emergence of reliable competing modalities including Reprint requests: Raffaele Giubbini MD, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy; giubbini@med.unibs.it, raffaele.giubbini@unibs.it J Nucl Cardiol 2016;23:1139–41. 1071-3581/$34.00 Copyright 2015 American Society of Nuclear Cardiology.

The time for radionuclide ventriculography resurrection is coming