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Garcia-Cardenas M, Espejel-Guzman A, Antonio-Villa NE, Michel-Vasquez A, Hernandez-Sandoval S, Serrano-Roman J, Fernandez-Badillo V, Solorzano-Pinot E, Zagal-Cardoso D, Keirns C, Alexanderson-Rosas E, Espinola-Zavaleta N. Diagnosis, performance and added value of assessing ventricular dyssynchrony by phase analysis in patients with three-vessel disease: A single-center cross-sectional study in Mexico. J Nucl Cardiol 2023; 30:1219-1229. [PMID: 36348246 DOI: 10.1007/s12350-022-03136-9] [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: 04/26/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Three-vessel disease (3VD) is a cardiovascular disorder that affects the three main coronary arteries. Gated myocardial perfusion SPECT (GMPS) evaluates ventricular function, synchrony, and myocardial perfusion. However, the diagnostic performance of GMPS parameters to assess 3VD has not been fully explored. AIMS To assess the univariate performance capacity of GMPS parameters, and to evaluate whether phase parameters could provide additional predictive value for the detection of patients with 3VD compared to control subjects. METHODS We designed paired retrospective samples of GMPS images of patients with 3VD (stenosis > 70% of left anterior descending, right coronary, and circumflex coronary arteries) and without 3VD. A GMPS in rest-stress protocol was performed using 99mTc-Sestamibi and thallium and analyzed with the 3D method. Area under the receiver-operating characteristic curves (AUROC), decision curve analyses and diagnostic test performance were obtained for univariable analyses and stepwise binomial logistic regression for multivariable performance. RESULTS 474 Patients were included: 237 with 3VD (84% males, mean age 61.7 ± 9.9 years) and 237 with normal GMPS (51% women, mean age 63.8 ± 10.6 years). The highest AUROC for perfusion parameters were recorded for SSS, SRS and TID. For dyssynchrony parameters, both entropy and bandwidth in rest and stress phases displayed the highest AUROC and diagnostic capacity to detect 3VD. A multivariate model with SRS ≥ 4, SDS ≥ 2, TID > 1.19 and sBW ≥ 48° displayed the highest diagnostic capacity (0.923 [95% CI 0.897-0.923]) to detect 3VD. CONCLUSION Perfusion and dyssynchrony were the parameters which were most able to discriminate patients with 3VD from those who did not have CAD.
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Affiliation(s)
- Mauricio Garcia-Cardenas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Adrian Espejel-Guzman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | | | - Ana Michel-Vasquez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Salvador Hernandez-Sandoval
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Valente Fernandez-Badillo
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Daniel Zagal-Cardoso
- M.D./Ph.D. (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Candace Keirns
- Shelby County Health Department, 814 Jefferson Ave., Memphis, TN, 38103, USA
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico.
- Department of Echocardiography, ABC Medical Center, P.A.I., Mexico, Mexico.
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Cortés CM, Aramayo G EN, Barboza PE, Crottogini A, Embon MA. Impact of early post-stress 99mTc sestamibi ECG-gated SPECT myocardial perfusion imaging on the detection of ischemic LV dyssynchrony: an early step in the stunning cascade. Int J Cardiovasc Imaging 2021; 37:1789-1798. [PMID: 33442855 DOI: 10.1007/s10554-020-02145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
Transient alterations in ventricular conduction and synchronized cardiac performance have been reported in experimental models of myocardial ischemia. In post-stress 99mTc-sestamibi-gated-SPECT myocardial perfusion imaging (MPI), the time elapsed between tracer injection and image acquisition could influence the detection of ischemic left ventricular mechanical dyssynchrony (LVMD). We aimed at evaluating whether early vs. delayed post-stress MPI improve ischemic LVMD detection using the phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) and to assess the correlation between stress-induced changes in SD and HB and other functional parameters. We prospectively studied 32 control subjects (Group-1) and 60 ischemic patients (Group-2). Stress-induced changes were calculated as stress minus rest (Δ). LVMD was defined as post-stress increases of either SD or HB. Group-2 showed higher ΔSD and ΔHB in early than in delayed images: early ΔSD: 1.63 (- 0.37 to 4.83) vs. delayed ΔSD: - 0.39 (- 3.82 to 1.74); early ΔHB: 2.50 (- 4 to 12) vs. ΔHB delayed: - 4 (- 15.75 to 4), all p < 0.01. ΔSD and ΔHB correlated linearly with ΔLV-ejection-fraction (EF) and ΔLV-end systolic-volume (ESV) in early images, all p < 0.01. Early images detected LVMD in more patients than delayed scans (78% vs. 38%; p < 0.01) All patients with LVEF drop in early post-stress evaluation had LVMD. Early post-stress images improve ischemic LVMD detection. Ischemic LVEF and LVESV changes correlate with ΔSD and ΔHB.
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Affiliation(s)
- Claudia Mariana Cortés
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
| | - E Natalia Aramayo G
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Paula Elizabeth Barboza
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | | | - Mario Alberto Embon
- Department of Images, Favaloro Foundation University Hospital, Buenos Aires, Argentina
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