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Romero-Farina G, Aguadé-Bruix S, Garcia EV, Castell-Conesa J. Integration of ventricular remodeling, synchrony and filling rate parameters to improve the assessment of left ventricular systolic function. Rev Esp Med Nucl Imagen Mol 2023; 42:393-402. [PMID: 37748687 DOI: 10.1016/j.remnie.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study is to assess the relationship between structural, remodeling, synchrony, and systolic left ventricular (LV) function parameters using gated-SPECT myocardial-perfusion-images (gSPECT-MPI). In addition, obtaining the cut-off values for end-diastolic LV-shape-index (EDLVsi), end-systolic LV-shape-index (ESLVsi), ECC (eccentricity-index) and PER, and developing a new index to evaluate different patterns of the LV systolic function. METHODS The study was approved by the Hospital's Ethical-Committee (PR[AG]168.2010), and all patients gave their informed consent. We analyzed prospectively 238 patients (age 63.4 ± 13 years) who underwent stress-rest gSPECT-MPI (control-group, n = 148; patients with previous myocardial infarction [MI], n = 90). RESULTS In the control group, with regard to remodeling parameters: the end-diastolic-volume-index (EDV) and the ECC were the parameters that influenced the EDLVsi (r2: 0.52, p < 0.001). EDV, PER, men, and the ECC were the parameters (r2: 0.44; p < 0.001) which influenced the ESLVsi. EDLVsi, ESLVsi, LVEF and the stroke-volume were the parameters (r2: 0.62; p < 0.001) which influenced the ECC. With regards to PER: LVEF, heart-rate, bandwidth, and the standard-deviation were the influencing parameters (r2: 0.76; p < 0.001). The cut-off values for EDLVsi, ESLVsi, ECC, and PER were 0.59, 0.42, 0.87, and 3.3, respectively. The PER, the ESLVsi and the bandwidth were the parameters related to patients with previous MI (AUC: 0.89); and they allow the assessment of different patterns of systolic function (PERRS-index: peak-emptying-rate, left ventricular-remodeling and synchrony). CONCLUSIONS The remodeling, synchrony and the systolic function parameters of the LV should be interpreted together (PERRS-index). In this way, we obtain different patterns of LV systolic function.
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Affiliation(s)
- G Romero-Farina
- Unidad de Cardiología Nuclear, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red: Enfermedades Cardiovasculares (CIBER-CV); Grupo de Imagen Médica Molecular (GRIMM); Vall d'Hebron Instituto de Investigación (VHIR), Barcelona, Spain; Departamento de Cardiología, Consorcio Sanitario l'Alt Penedés y Garraf (CSAPG), Barcelona, Spain.
| | - S Aguadé-Bruix
- Unidad de Cardiología Nuclear, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red: Enfermedades Cardiovasculares (CIBER-CV); Grupo de Imagen Médica Molecular (GRIMM)
| | - E V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - J Castell-Conesa
- Unidad de Cardiología Nuclear, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red: Enfermedades Cardiovasculares (CIBER-CV); Grupo de Imagen Médica Molecular (GRIMM)
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do Nascimento EA, Fernandes FDA, Mira PAC, He Z, Zhou W, Mesquita CT. Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling. Arq Bras Cardiol 2023; 120:e20220077. [PMID: 37018787 PMCID: PMC10392842 DOI: 10.36660/abc.20220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/25/2022] [Accepted: 11/23/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). OBJECTIVE The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. METHODS Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. RESULTS At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. CONCLUSIONS LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.
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Affiliation(s)
- Erivelton Alessandro do Nascimento
- Universidade Federal FluminenseHospital Universitário Antônio PedroPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Serviço de Cardiologia, Hospital Universitário Antônio Pedro e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
- Instituto Estadual de Cardiologia Aloysio de CastroDepartamento de Arritmias CardíacasRio de JaneiroRJBrasilInstituto Estadual de Cardiologia Aloysio de Castro – Departamento de Arritmias Cardíacas, Rio de Janeiro, RJ – Brasil
| | - Fernando de Amorim Fernandes
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
| | - Pedro Augusto Carvalho Mira
- Universidade Federal FluminenseLaboratório de Ciências do ExercícioNiteróiRJBrasilUniversidade Federal Fluminense – Laboratório de Ciências do Exercício, Niterói, RJ – Brasil
| | - Zhuo He
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Weihua Zhou
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Claudio Tinoco Mesquita
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
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Hämäläinen H, Laitinen TM, Hedman M, Hedman A, Kivelä A, Laitinen TP. Cardiac remodelling in association with left ventricular dyssynchrony and systolic dysfunction in patients with coronary artery disease. Clin Physiol Funct Imaging 2022; 42:413-421. [PMID: 35848312 PMCID: PMC9796742 DOI: 10.1111/cpf.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/30/2022] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), ischaemic cardiomyopathy may result in progressive cardiac remodelling and left ventricular (LV) dysfunction. Myocardial perfusion imaging (MPI) can be used to quantify LV size and shape, mechanical dyssynchrony (LVMD) and ejection fraction (EF) as well as myocardial ischaemia and injury extents. We investigated the prevalence of LV remodelling (LVR) in patients with CAD and the relationship between LVR, LVMD and EF. METHODS Three hundred twenty-six patients with CAD were evaluated. The EF and end-diastolic volume (EDV) were measured using MPI. LVMD was assessed using phase analysis. LVR was characterised according to LV dilatation or increased shape indices (systolic shape index [SIES] and diastolic shape index [SIED]). RESULTS LVR were observed in 41% of CAD patients. EDV, SIES and SIED were larger in patients with LVMD or low EF. After adjustment for age, sex and infarct and ischaemia extents, phase histogram bandwidth correlated with EDV (r = 0.218) and SIES (r = 0.266) and EF correlated with EDV (r = -0.535), SIES (r = -0.554) and SIED (r = -0.217, p < 0.001 for all). CONCLUSIONS LVR is frequently seen in patients with CAD and may be detected even before the development of symptomatic heart failure. A large LV volume and a more spherical-shaped LV were associated with LVMD and low EF, highlighting the close relationships between remodelling and systolic dyssynchrony and dysfunction. MPI is useful for assessing LVR by providing information about LV size and shape, which changes from an ellipsoid towards a spherical form in the development of ischaemic cardiomyopathy.
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Affiliation(s)
- Hanna Hämäläinen
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland,Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Tiina M. Laitinen
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
| | - Marja Hedman
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland,Department of Cardiothoracic SurgeryKuopio University HospitalKuopioFinland
| | - Antti Hedman
- Heart CenterKuopio University HospitalKuopioFinland
| | - Antti Kivelä
- Heart CenterKuopio University HospitalKuopioFinland
| | - Tomi P. Laitinen
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland,Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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He Z, de Amorim Fernandes F, do Nascimento EA, Garcia EV, Mesquita CT, Zhou W. Incremental value of left ventricular shape parameters measured by gated SPECT MPI in predicting the super-response to CRT. J Nucl Cardiol 2022; 29:1537-1546. [PMID: 33506382 PMCID: PMC10959067 DOI: 10.1007/s12350-020-02469-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive value of left ventricular (LV) shape parameters measured by gated SPECT myocardial perfusion imaging (MPI) in super-responders enrolled in the VISION-CRT trial. METHODS One hundred and ninety-nine patients who met standard criteria for CRT from multiple centers were enrolled in this study. End-systolic eccentricity (ESE) and end-diastolic eccentricity (EDE) were measures of LV shape. Super-responders were the patients who had a relative increase in left ventricular ejection fraction (LVEF) ≥ 15%. RESULTS Complete data were obtained in 165 patients, and 43.6% of them were classified as super-responders. ESE was an independent predictor of CRT super-responders in univariate (OR 12.59, 95% CI 1.56-101.35, P = .017) and multivariate analysis (OR 35.71, 95% CI 1.66-766.03, P = .006). ESE had an incremental value over significant clinical and SPECT imaging variables, including angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker, coronary artery disease, myocardial infarction, LVEF, end-diastolic volume index, and scar burden (AUC 0.82 vs. 0.80, sensitivity 0.68 vs. 0.65, specificity 0.82 vs. 0.78). CONCLUSIONS LV shape parameters derived from gated SPECT MPI have the promise to improve the prediction of the super-response to CRT. Moreover, ESE provides incremental value over existing clinical and nuclear imaging variables.
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Affiliation(s)
- Zhuo He
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | | | | | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Claudio T Mesquita
- Nuclear Medicine Department, Hospital Universitario Antonio Pedro-EBSERH-UFF, Niteroi, Brazil.
- Nuclear Medicine Department, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil.
| | - Weihua Zhou
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
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Miller RJH, Sharir T, Otaki Y, Gransar H, Liang JX, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Tamarappoo BK, Dey D, Berman DS, Slomka PJ. Quantitation of Post-Stress Change in Ventricular Morphology Improves Risk Stratification. J Nucl Med 2021; 62:1582-1590. [PMID: 33712535 DOI: 10.2967/jnumed.120.260141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Shape index and eccentricity index are measures of left ventricular morphology. Although both measures can be quantified with any stress imaging modality, they are not routinely evaluated during clinical interpretation. We assessed their independent associations with major adverse cardiovascular events (MACE), including measures of post-stress change in shape index and eccentricity index. Methods: Patients undergoing single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) between 2009 and 2014 from the REFINE SPECT registry were studied. Shape index (ratio between the maximum LV diameter in short axis and ventricular length) and eccentricity index (calculated from orthogonal diameters in short axis and length) were calculated in end-diastole at stress and rest. Multivariable analysis was performed to assess independent associations with MACE (death, non-fatal myocardial infarction, unstable angina, or late revascularization). Results: In total, 14,016 patients, mean age 64.3 ± 12.2 and 8469 (60.4%) male, were included. MACE occurred in 2120 patients during a median follow-up of 4.3 years (interquartile range 3.4 - 5.7). Rest, stress, and post-stress change in shape and eccentricity indices were associated with MACE in unadjusted analyses (all p<0.001). However, in multivariable models only post-stress change in shape index (adjusted HR 1.38, p<0.001) and eccentricity index (adjusted HR 0.80, P = 0.033) remained associated with MACE. Conclusion: Two novel measures, post-stress change in shape index and eccentricity index, were independently associated with MACE and improved risk estimation. Changes in ventricular morphology have important prognostic utility and should be included in patient risk estimation following SPECT MPI.
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Affiliation(s)
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center
| | - Yuka Otaki
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | - Heidi Gransar
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | - Joanna X Liang
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | | | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center
| | | | | | | | | | | | | | | | - Balaji K Tamarappoo
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | - Damini Dey
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | - Daniel S Berman
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
| | - Piotr J Slomka
- Dept. of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, United States
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Tomas V, Nestor V. Is left ventricular systolic index the new kid in the block? J Nucl Cardiol 2019; 26:1157-1160. [PMID: 29359270 PMCID: PMC6054899 DOI: 10.1007/s12350-017-1170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Vita Tomas
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Vita Nestor
- Cardiovascular Division, Italian Hospital of Rosario, Rosario, Argentina.
- Cardiovascular Instituto of Rosario "Dr. González Sabathie", Rosario, Argentina.
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Germano G, Slomka PJ. Assessing LV remodeling in nuclear cardiology. J Nucl Cardiol 2019; 26:233-235. [PMID: 28616800 DOI: 10.1007/s12350-017-0957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Stress Protocol and Myocardial Perfusion Imaging Accuracy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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