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Peix A, Jimenez-Heffernan A, Devasenapathy N, Sobic-Saranovic D, Vitola J, Giubbini R, Rodella C, Haque SU, Alexanderson Rosas E, Ozkan E, Keng YJF, Dondi M, Paez D, Karthikeyan G. Correlates of markers of dyssynchrony in patients with STEMI and multivessel disease: an analysis from the IAEA SPECT STEMI trial. Nucl Med Commun 2024; 45:666-672. [PMID: 38745501 DOI: 10.1097/mnm.0000000000001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND In this substudy of the Value of Gated-SPECT MPI for Ischemia- Guided PCI of non-culprit vessels in STEMI Patients with Multi vessel Disease after primary PCI trial after primary PCI we aim to assess if infarct size affects conventional measures of dyssynchrony at rest. Additionally, we explore if there is an independent correlation of stress-inducible ischemia with dyssynchrony at rest. METHODS The 48 patients with imaging at randomization were analyzed. Gated-single-photon emission computed tomography (SPECT) MPI with vasodilator stress and technetium-99m-labeled tracers was performed. The phase histogram bandwidth (HBW), phase SD, and entropy were obtained with the QGS software. Correlation between dyssynchrony at rest and infarct size and inducible ischemia was performed using the Spearman test. RESULTS According to normal database limits dyssynchrony parameters at rest were abnormal for men. In women only HBW was abnormal. Correlation between the summed rest score with dyssynchrony was significant only for entropy ( P = 0.035). No correlation was observed for dyssynchrony and stress-induced ischemia. CONCLUSION Entropy, as a measure of dyssynchrony, has potential in the assessment of patients with STEMI and multivessel disease after primary PCI. Smaller residual myocardial scars in PCI-reperfused patients with STEMI may contribute to the lack of correlation between dyssynchrony at rest and infarct size and stress-induced ischemia, respectively.
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Affiliation(s)
- Amalia Peix
- Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, Havana, Cuba,
| | | | | | | | - Joao Vitola
- Quanta Diagnóstico por Imagem, Curitiba, Brazil,
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy,
| | - Carlo Rodella
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy,
| | - Saif-Ul Haque
- Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan,
| | | | - Elgin Ozkan
- Department of Nuclear Medicine, Medical School, Ankara University, Ankara, Turkey,
| | - Yung Jih Felix Keng
- Center for Nuclear Medicine, University Clinical Centre of Serbia, Belgrade, Serbia,
- Quanta Diagnóstico por Imagem, Curitiba, Brazil,
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- George Institute for Global Health, New Delhi, India,
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Ganesan Karthikeyan
- George Institute for Global Health, New Delhi, India,
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Jalkh K, AlJaroudi W. Left ventricular mechanical dyssnchrony: A potential new marker for 3-vessel CAD. J Nucl Cardiol 2023; 30:1230-1234. [PMID: 36864242 DOI: 10.1007/s12350-023-03232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Khalil Jalkh
- Division of Cardiovascular Medicine, Augusta University-Medical College of Georgia, Office BB-6520B, Augusta, GA, USA
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, Augusta University-Medical College of Georgia, Office BB-6520B, Augusta, GA, USA.
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Zhang F, Wang J, Shao X, Xu M, Chen Y, Fan S, Shi Y, Liu B, Yu W, Li X, Xu M, Yang M, Xi X, Wu Z, Li S, Wang Y. Longitudinal evaluation of diastolic dyssynchrony by SPECT gated myocardial perfusion imaging early after acute myocardial infarction and the relationship with left ventricular remodeling progression in a swine model. J Nucl Cardiol 2022; 29:1520-1533. [PMID: 33506381 DOI: 10.1007/s12350-020-02483-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Left ventricular diastolic dyssynchrony (LVDD), a dyssynchronous relaxation pattern, has been known to develop after myocardial damage. We aimed to evaluate the dynamic changes in LVDD in the early stage of acute myocardial infarction (AMI) by phase analysis of 99mtechnetium methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and explore its relationship with the progression of left ventricular remodeling (LVR). METHODS The left anterior descending coronary arteries of 16 Bama miniature swine were occluded with a balloon to build AMI models. Animals were imaged by SPECT GMPI before AMI and at 1 day, 1 week and 4 weeks after AMI, and quantitative analysis was performed to determine the extent of left ventricle (LV) perfusion defects, left ventricular systolic dyssynchrony (LVSD) and the LVDD parameters: phase histogram bandwidth (PBW) and phase standard deviation (PSD). Echocardiography was simultaneously applied to evaluate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the LVDD parameters: Te-12-diff and Te-12-SD. Myocardial injury markers were measured, and 12-lead ECGs were performed. The degree of LVR progression was defined as ΔLVESV (%) = (LVESVAMI4weeks - LVESVAMI1day)/LVESVAMI1day. RESULTS Thirteen swine completed the study. LVDD parameters changed dynamically at different time points after AMI. LVDD occurred as early as 1 day after AMI, peaked at 1 week, and trended toward a partial recovery at 4 weeks. Phase analysis on SPECT GMPI showed a significant correlation with tissue Doppler imaging for the assessment of LVDD during the longitudinal evaluation (r = 0.569 to 0.787, both P <0.05). During the univariate and multivariate regression analyses, the LVDD parameters PBW and PSD as of 1 day after AMI were significantly associated with the progression of LVR, respectively (PBW, β = 0.004, 95% CI 0.001 to 0.007, P = 0.024; PSD, β = 0.008, 95% CI 0.000 to 0.017, P = 0.049). Adjusted smooth curve fitting and threshold effect analysis indicated PBW and PSD break-point values of 142° and 60.4°, respectively, to predict the progression of LVR after AMI. CONCLUSIONS Phase analysis of SPECT GMPI can accurately and reliably characterize LVDD. LVDD occurred on the first day after AMI, reached its peak at 1 week, and partially recovered at 4 weeks after AMI. LVDD as evaluated by phase analysis of SPECT GMPI early after AMI was significantly associated with the progression of LVR. The early assessment of LVDD after AMI may provide helpful information for predicting the progression of LVR in the future.
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Affiliation(s)
- Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Min Xu
- Department of Echocardiogram, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Shengdeng Fan
- Department of Anesthesiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Xiaoxia Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Mei Xu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Minfu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoying Xi
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China.
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AlJaroudi W. Left ventricular mechanical dyssynchrony in patient with CAD: The Saga continues. J Nucl Cardiol 2021; 28:3021-3024. [PMID: 32875523 DOI: 10.1007/s12350-020-02318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
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Juarez-Orozco LE, Monroy-Gonzalez AG, van der Zant FM, Hoogvorst N, Slart RHJA, Knol RJJ. Ventricular synchrony is not significantly determined by absolute myocardial perfusion in patients with chronic heart failure: A 13N-ammonia PET study. J Nucl Cardiol 2020; 27:2234-2242. [PMID: 30443751 PMCID: PMC7749096 DOI: 10.1007/s12350-018-01507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/22/2018] [Indexed: 10/29/2022]
Abstract
BACKGROUND It is thought that heart failure (HF) patients may benefit from the evaluation of mechanical (dys)synchrony, and an independent inverse relationship between myocardial perfusion and ventricular synchrony has been suggested. We explore the relationship between quantitative myocardial perfusion and synchrony parameters when accounting for the presence and extent of fixed perfusion defects in patients with chronic HF. METHODS We studied 98 patients with chronic HF who underwent rest and stress Nitrogen-13 ammonia PET. Multivariate analyses of covariance were performed to determine relevant predictors of synchrony (measured as bandwidth, standard deviation, and entropy). RESULTS In our population, there were 43 (44%) women and 55 men with a mean age of 71 ± 9.6 years. The SRS was the strongest independent predictor of mechanical synchrony variables (p < .01), among other considered predictors including: age, sex, body mass index, smoking, diabetes mellitus, dyslipidemia, hypertension, rest myocardial blood flow (MBF), and myocardial perfusion reserve (MPR). Results were similar when considering stress MBF instead of MPR. CONCLUSIONS The existence and extent of fixed perfusion defects, but not the quantitative PET myocardial perfusion parameters (sMBF and MPR), constitute a significant independent predictor of ventricular mechanical synchrony in patients with chronic HF.
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Affiliation(s)
- Luis Eduardo Juarez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700RB, Groningen, The Netherlands.
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Andrea G Monroy-Gonzalez
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700RB, Groningen, The Netherlands
| | - Friso M van der Zant
- Cardiac Imaging Division Alkmaar, Department of Nuclear Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Nick Hoogvorst
- Cardiac Imaging Division Alkmaar, Department of Nuclear Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700RB, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Remco J J Knol
- Cardiac Imaging Division Alkmaar, Department of Nuclear Medicine, Northwest Clinics, Alkmaar, The Netherlands
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Padrón K, Peix A, Cabrera L, Garcia J, Rodriguez L, Carrillo R, Mena E, Fernandez Y. Could myocardial viability be related to left ventricular dyssynchrony? Simultaneous evaluation by gated SPECT-MPI. J Nucl Cardiol 2020; 27:1158-1167. [PMID: 32246407 DOI: 10.1007/s12350-020-02047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/08/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI). METHODS Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included. They underwent a two-day rest/nitroglycerine (NTG) study GSPECT MPI to determine the myocardial viability. Patients with a nitrate-induced uptake increase of > 10% vs baseline, in at least, two consecutive dysfunctional segments were considered viable as well as those who showed no improvement in the uptake but the uptake was > 50% on post NTG study. Patients with no nitrate-induced uptake increase of > 10% and the uptake of < 50% were considered non-viable. Perfusion, function and LVCD were compared in 25 viable patients vs 29 non-viable patients at baseline and after NTG administration. RESULTS After NTG administration, in the viable group, the LVEF increased (36.44 ± 6.64% vs 39.84 ± 6.39%) and the end-systolic volume decreased significantly (119.28 ± 31.77 mL vs 109.08 ± 33.17 mL) (P < 0.01). These patients also experienced a significant reduction in the LVCD variables: phase standard deviation was reduced in the post NTG study (57.77° ± 19.47° vs 52.02° ± 17.09°) as well as the phase histogram bandwidth (190.20° ± 78.83° vs 178.0° ± 76.14°) (P < 0.05). Functional and LVCD variables remained similar in the non-viable patients (P > 0.05). CONCLUSION In patients with IDC and depressed LVEF, the myocardial viability detected by rest/ NTG GSPECT MPI, might determine LVCD improvement.
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Affiliation(s)
- Kenia Padrón
- National Institute of Cardiology, Havana City, Cuba.
| | - Amalia Peix
- National Institute of Cardiology, Havana City, Cuba
| | | | | | | | | | - Erick Mena
- National Institute of Cardiology, Havana City, Cuba
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Myocardial perfusion imaging detects mechanical dyssynchrony in left ventricular infarcted and noninfarcted areas early after acute myocardial infarction in a porcine model. Nucl Med Commun 2018; 40:115-123. [PMID: 30418381 DOI: 10.1097/mnm.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony (LVMD) is closely associated with left ventricular dysfunction and poor prognosis in patients with acute myocardial infarction (AMI). However, whether mechanical dyssynchrony is present in the noninfarcted areas remains controversial. This research aimed to quantitatively evaluate the global and regional mechanical dyssynchrony early after AMI by phase analysis of single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and to further explore the related influencing factors. MATERIALS AND METHODS Of 11 Bama suckling pigs, eight animals were successfully subjected to left anterior descending artery occlusion by balloon to generate porcine AMI models and completed the study. SPECT GMPI was performed before AMI and at 1 day, 1 week, and 4 weeks after AMI. The global bandwidth (BW), SD, entropy, total perfusion deficit, summed rest score, regional BW, regional summed motion score, and regional summed thickening score were measured by SPECT GMPI. RESULTS The global BW, SD, and entropy values significantly increased after AMI and showed no significant change among the three time points after AMI. The BW in the infarcted area (left anterior descending artery-dominated area) at 1 day, 1 week, and 4 weeks after AMI was significantly higher than that before AMI, as was the BW in the noninfarcted areas (left circumflex artery-dominated and right coronary artery-dominated areas), which revealed that there was less dyssynchrony in the noninfarcted areas than in the infarcted area at the three time points after AMI. The global BW was positively correlated with the scar burden measured by summed rest score (r=0.709-0.832, all P<0.05), whereas the regional BW in the noninfarcted areas after AMI showed moderate to good correlation with regional summed motion score (r=0.733-0.875, all P<0.05) and regional summed thickening score (r=0.713-0.889, all P<0.05). CONCLUSION LVMD occurs early on the first day after AMI, with no significant worsening over the next 4 weeks. Mechanical dyssynchrony was present in both the infarcted and noninfarcted areas. The global LVMD is mainly influenced by the scar burden, and the regional mechanical dyssynchrony in the noninfarcted areas is closely associated with the abnormal regional wall thickening and motion, which are indicative of reduced myocardial contractility.
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Aguadé-Bruix S, Romero-Farina G, Candell-Riera J, Pizzi MN, García-Dorado D. Mechanical dyssynchrony according to validated cut-off values using gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2018; 25:999-1008. [PMID: 27804074 DOI: 10.1007/s12350-016-0684-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to establish different degrees of mechanical dyssynchrony according to validated cut-off (CO) values of myocardial perfusion gated SPECT phase analysis parameters (SD, standard deviation; B, bandwidth; S, skewness; K, kurtosis). METHODS Using Emory Cardiac Toolbox™, we prospectively analyzed 408 patients (mean age 64.1 years, 26.7% female), divided into a control group of 150 normal subjects and a validation group of 258 patients (left bundle branch block: 17.8%, right bundle branch block: 8.9%. atrial fibrillation: 16.3%, coronary revascularization: 30%, dilated cardiomyopathy: 7.4%. valvulopathies: 2.7%, ischemic test: 45.3%) with ischemic and non-ischemic cardiac diseases, by means of phase analysis. RESULTS Agreement of CO values (SD > 18.4°; B > 51°; S ≤ 3.2; K ≤ 9.3) used to discriminate between normal subjects and patients was strong (c-statistic 0.9; 95% CI 0.98-0.99). Four degrees of dyssynchrony were found according to the number of abnormal phase parameters. All patients with mechanical and electrical criteria for cardiac resynchronization therapy (CCRT) (n: 82) had Grade 2 to 4 (two to four abnormal phase parameters). Agreement of CO values (SD > 40.2°; B > 132°; S ≤ 2.3; K ≤ 4.6) used to discriminate between patients with and without CCRT was strong (c-statistic 0.8; 95% CI 0.79-0.87) but 12% of patients with CCRT did not have any of these abnormal phase parameters. CONCLUSIONS The discriminatory capacity of gated SPECT phase analysis parameters between normal subjects and patients, and between patients with and without CCRT, is very good, making it possible to define different degrees of mechanical dyssynchrony.
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Affiliation(s)
- Santiago Aguadé-Bruix
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Guillermo Romero-Farina
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Candell-Riera
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María N Pizzi
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David García-Dorado
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Ferrando-Castagnetto F, Ricca-Mallada R, Vidal A, Ferrando R. [Effects of prolonged endocardial stimulation on left ventricular mechanical synchrony. A pilot study applying gated-SPECT phase analysis. Endocardial stimulation and dyssynchrony]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:307-315. [PMID: 28131806 DOI: 10.1016/j.acmx.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022] Open
Abstract
OBJETIVE To evaluate left ventricular mechanical dyssynchrony (LVMD) associated with prolonged right ventricular pacing through an innovative imaging technique as a pilot study in Uruguay. METHODS A 99mTc-MIBI gated-SPECT and phase analysis was performed in 12 patients with pace-makers implanted at least one year before scintigraphy, due to advanced atrioventricular block. Clinical data, QRS duration, rate, mode and site of pacing in right ventricle, chamber diameters, presence and extension of myocardial scar and ischaemia, as well as LVEF at rest, were recorded. Using V-Sync of Emory Cardiac Toolbox, a standard deviation (PSD) and bandwidth (PBW) from rest phase histogram was obtained and these indexes were compared with controls in the subgroups of patients with LVEF≥50% and <50%. RESULTS Patients with prolonged RV endocardial pacing exhibited marked LVMD. More severe dyssynchrony was found in patients with impaired LVEF than in patients with preserved LVEF (PSD: 46.67o vs. 26.81o, P<.05; PBW: 144.33o vs. 77.41o, P<.05). Higher left ventricle diameters, extensive infarct, or significant ischaemia were found in patients with impaired LVEF. CONCLUSIONS Chronic right ventricular pacing was invariably associated with LVMD, even when systolic function was preserved. Phase analysis could be a potentially useful technique to evaluate LMVD associated with myocardial scar in patients with pacemakers, and to decide promptly the upgrading to biventricular pacing.
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Affiliation(s)
- Federico Ferrando-Castagnetto
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay; Servicio de Medicina Nuclear-Centro Asistencial del Sindicato Médico, Montevideo, Uruguay.
| | - Roberto Ricca-Mallada
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Vidal
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rodolfo Ferrando
- Servicio de Medicina Nuclear-Centro Asistencial del Sindicato Médico, Montevideo, Uruguay
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Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease. Eur J Nucl Med Mol Imaging 2016; 44:259-266. [DOI: 10.1007/s00259-016-3542-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Peix A, Cabrera LO, Padrón K. Nuclear Cardiology in the Management of Patients with Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Romero-Farina G, Aguadé-Bruix S, Candell-Riera J, Pizzi MN, García-Dorado D. Cut-off values of myocardial perfusion gated-SPECT phase analysis parameters of normal subjects, and conduction and mechanical cardiac diseases. J Nucl Cardiol 2015; 22:1247-58. [PMID: 26017712 DOI: 10.1007/s12350-015-0143-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine the cut-off values of gated myocardial perfusion rest SPECT phase analysis parameters of normal subjects, and conduction (CCD) and mechanical cardiac diseases (MCD). METHODS We prospectively analyzed 455 patients by means of phase analysis using SyncTool™ (Emory Cardiac Toolbox™). Of these, 150 corresponded to the control group (group 1, normal subjects) and 305 corresponded to patients with cardiac diseases (group 2, 63 with only CCD, 121 with only MCD, and 121 with CCD plus MCD). The optimal cut-off (CO) values of the peak phase (P), standard deviation (SD), bandwidth (B), skewness (S), and kurtosis (K) for discriminating between normal and dyssynchrony were obtained. RESULTS In order to differentiate group 1 from group 2, CO of SD > 18.4 and CO of B > 51 were the most sensitive parameters (75.7%, 95% CI 70.5%-80.4%, and 78.7%, 95% CI 73.7%-83.1%, respectively), and CO of S ≤ 3.2 and CO of K ≤ 9.3 were the most specific (92%, 95% CI 86.4%-95.8%, and 94.7%, 95% CI 89.8%-97.7%, respectively). In order to differentiate patients with CCD and MCD, CO values were SD > 26.1, B > 70, S ≤ 2.89, and K ≤ 10.2. In order to differentiate between patients with (n: 26) and without (n: 216) criteria of cardiac resynchronization therapy, CO values were SD > 40.2, B > 132, S ≤ 2.3, and K ≤ 4.6. CONCLUSIONS In this pilot study, different CO values of phase histogram parameters were observed between normal subjects and patients with conduction and MCD, and between patients with and without criteria of cardiac resynchronization therapy.
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Affiliation(s)
- Guillermo Romero-Farina
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Santiago Aguadé-Bruix
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaume Candell-Riera
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María N Pizzi
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David García-Dorado
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Gated SPECT myocardial perfusion imaging, intraventricular synchronism, and cardiac events in heart failure. Clin Nucl Med 2014; 39:498-504. [PMID: 24686210 DOI: 10.1097/rlu.0000000000000428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the ability of rest gated SPECT myocardial perfusion imaging (MPI) and intraventricular synchronism, to identify heart failure (HF) patients most likely to experience cardiac events. METHODS We studied 165 patients with left ventricular ejection fraction of less than 40%, who were divided in 2 groups according to the diagnosis of coronary artery disease (group 1: 136 patients) or not (group 2: 29 patients). All underwent a rest gated SPECT MPI. RESULTS In 160 patients, the MPI was abnormal. Mean summed rest score was 17 ± 6 (group 1) versus 10 ± 6 (group 2), P < 0.0001. Mean volumes showed a marked ventricular dilation, slightly higher among nonischemic. The mean value of the phase-derived SD was 70 ± 19 (group 1) versus 59 ± 21 degrees (group 2), P = 0.016. The histogram bandwidth showed no significant differences. Forty-four (39%) of 114 patients showed some kind of event during the follow-up. The more frequent events were HF progression (13%) and acute coronary syndrome (11%). The highest odds ratios for prediction of events were 1.91 (phase SD), 1.66 (etiology), and 1.55 (summed rest score), although the association was not significant. CONCLUSIONS A rest gated SPECT is a valid approach to identify HF patients most likely to experience cardiac events.
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Gimelli A, Liga R, Genovesi D, Giorgetti A, Kusch A, Marzullo P. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study. Eur J Nucl Med Mol Imaging 2013; 41:946-55. [DOI: 10.1007/s00259-013-2640-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
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