1
|
Caliskan B, Inanir M. SPECT myocardial perfusion imaging for the evaluation of left ventricular mechanical dyssynchrony in obese patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39031559 DOI: 10.1002/jcu.23752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Left ventricular dyssynchrony (LVD), the loss of coordinated contraction in the left ventricle, is an early sign of heart failure. LVD can be assessed using phase analysis techniques with gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). This study aimed to investigate the impact of obesity on LVD through phase analysis. METHODS We retrospectively enrolled 152 obese patients and 80 age- and sex-matched nonobese patients who showed normal myocardial perfusion and normal left ventricular ejection fraction (LVEF) on MPI. Phase standard deviation (PSD) and phase histogram bandwidth (PBW), as phase analysis parameters, were compared between patients with and without obesity. RESULTS Although PSD values were within the normal range (cut-off value >23) for both groups, the PSD values of obese patients were higher than those of the nonobese (20.49 ± 8.66 vs. 14.81 ± 4.93; p < 0.05). PBW values of obese patients were statistically significantly higher than those of the nonobese (57.03 ± 23.17 vs. 41.40 ± 9.96; p < 0.05). The PBW values of obese patients exceeded the normal limits (cut-off value >49). A weak positive correlation was observed between body mass index (BMI) and PBW values in obese patients (r = 0.181, p < 0.05). In patients of normal weight, no correlations were found between BMI and phase analysis parameters. CONCLUSION LVD may develop in obese patients, even when myocardial perfusion and ejection fraction are preserved. The use of phase analysis with gated SPECT could be an additional finding improving the early detection of left ventricular dyssynchrony in obese patients.
Collapse
Affiliation(s)
- Billur Caliskan
- Department of Nuclear Medicine, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Mehmet Inanir
- Department of Cardiology, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| |
Collapse
|
2
|
Kuronuma K, Matsumoto N, Van Kriekinge SD, Slomka PJ, Berman DS. Usefulness of phase analysis on ECG gated single photon emission computed tomography myocardial perfusion imaging. J Cardiol 2023; 82:87-92. [PMID: 36858173 DOI: 10.1016/j.jjcc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
Electrocardiogram (ECG)-gated single photon emission computed tomography myocardial perfusion imaging (GSPECT-MPI) is widely used for assessing coronary artery disease. Phase analysis on GSPECT-MPI can assess left ventricular mechanical dyssynchrony quantitatively on standard GSPECT-MPI alongside myocardial perfusion and function assessment. It has been shown that phase variables by GSPECT-MPI correlate well with tissue Doppler imaging by echocardiography. Main phase variables quantified by GSPECT-MPI are entropy, bandwidth, and phase standard deviation. Although those variables are automatically obtained from several software packages including Quantitative Gated SPECT and Emory Cardiac Toolbox, the methods for their measurement vary in each package. Several studies have shown that phase analysis has predictive value for response to cardiac resynchronization therapy and prognostic value for future adverse cardiac events beyond standard GSPECT-MPI variables. In this review, we summarize the basics of phase analysis on GSPECT-MPI and usefulness of phase analysis in clinical practice.
Collapse
Affiliation(s)
- Keiichiro Kuronuma
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Nihon University, Tokyo, Japan.
| | | | - Serge D Van Kriekinge
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
3
|
Huang J, Mitchell AJ, Garcia EV, Cooke CD, Folks R, Pernetz M, Goyal A, Piccinelli M, Nye JA. Left Ventricular Strain from Myocardial Perfusion PET Imaging: Method Development and Comparison to 2-Dimensional Echocardiography. J Nucl Med 2023; 64:932-939. [PMID: 36522185 PMCID: PMC10241013 DOI: 10.2967/jnumed.122.264516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to develop a measure of longitudinal, radial, and circumferential myocardial strain at rest and regadenoson during pharmacologic stress using 82Rb PET electrocardiography-gated myocardial perfusion imaging (MPI). Methods: We retrospectively identified 80 patients who underwent rest and regadenoson-stress CT attenuation-corrected 82Rb PET and had a standard resting transthoracic echocardiogram (TTE) with global longitudinal strain (GLS) analysis within 3 mo. A method was developed to compute longitudinal, radial, and circumferential strain from PET MPI at stress and rest. PET MPI-derived strain and left ventricular function were compared with resting TTE measures as the clinical reference standard. Interobserver agreement of PET MPI strain and left ventricular ejection fraction processing was reported. Results: Longitudinal strain assessed with resting TTE GLS showed good correlation with PET MPI at stress (r = 0.68, P < 0.001) and rest (r = 0.58, P < 0.001). Resting TTE GLS also correlated with PET MPI radial strain at stress (r = -0.70, P < 0.001) and rest (r = -0.59, P < 0.001) and circumferential strain at stress (r = 0.67, P < 0.001) and rest (r = 0.69, P < 0.001). The left ventricular ejection fraction showed good correlation between resting TTE and PET MPI at stress (r = 0.83, P < 0.001) and rest (r = 0.80, P < 0.001). Bland-Altman analysis indicated positive bias of TTE GLS compared with PET MPI longitudinal strain at stress (mean difference = 5.1%, 95% CI = [-2.5, 12.7]) and rest (mean difference = 4.2%, 95% CI = [-4.3, 12.8]). Reproducibility of PET MPI longitudinal strain showed good agreement at stress (concordance correlation coefficient = 0.73, P < 0.001) and rest (concordance correlation coefficient = 0.74, P < 0.001), with Bland-Altman analysis showing a small bias in the longitudinal direction at stress (mean difference = -0.2%) and rest (mean difference = -1.0%). Conclusion: Strain measured with PET MPI using an automated technique correlated well with resting GLS strain obtained by TTE, and the measure is reproducible. Strain from PET MPI should be investigated further to establish reference ranges and assess its value in routine clinical practice.
Collapse
Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Adam J Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia;
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Maria Pernetz
- Emory Adult Congenital Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Wang H, Li X, Yan R, Li P, Han X. A Novel Pacing Method to Obtain Synchronous Biventricular Activation: Synchronized Pacing of Left and Right Bundle Branches. Can J Cardiol 2023; 39:14-17. [PMID: 36252905 DOI: 10.1016/j.cjca.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Haixiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China; Department of Cardiology, Xinzhou People's Hospital, Xinzhou, Shanxi, China.
| | - Xiaofang Li
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Yan
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Pengfei Li
- Department of Cardiology, Xinzhou People's Hospital, Xinzhou, Shanxi, China
| | - Xuebin Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| |
Collapse
|
6
|
Sakatani T, Kasahara T, Irie D, Tsubakimoto Y, Matsuo A, Fujita H, Inoue K. Prognostic value of left ventricular mechanical dyssynchrony induced by exercise stress in patients with normal myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2022; 29:1-10. [PMID: 33083982 DOI: 10.1007/s12350-020-02389-6] [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: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. METHODS We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). RESULTS During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P = .001, PSD: 14 ± 9 vs 10 ± 6, P = .001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P = .026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P = .006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P = .019), but the pharmacological stress bandwidth had no influence on MCEs. CONCLUSIONS LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events.
Collapse
Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan.
| | - Takeru Kasahara
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Daisuke Irie
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Hiroshi Fujita
- Department of Cardiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| |
Collapse
|
7
|
Vigdor A, Bravo PE. Mechanical Dyssynchrony with Gated Myocardial Perfusion SPECT: Reproducibility is the Key. J Nucl Cardiol 2022; 29:962-964. [PMID: 33389642 DOI: 10.1007/s12350-020-02463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron Vigdor
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
| |
Collapse
|
8
|
Hämäläinen H, Corovai A, Laitinen J, Laitinen TM, Hedman M, Hedman A, Kivelä A, Laitinen TP. Myocardial ischemia and previous infarction contribute to left ventricular dyssynchrony in patients with coronary artery disease. J Nucl Cardiol 2021; 28:3010-3020. [PMID: 32869165 PMCID: PMC8709814 DOI: 10.1007/s12350-020-02316-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
AIMS The aim of this study was to characterize determinants of left ventricular mechanical dyssynchrony (LVMD) in patients with coronary artery disease (CAD). METHODS Medical records and results of myocardial perfusion SPECT/CT studies were evaluated in 326 patients with previously diagnosed CAD. LVMD was assessed with the phase analysis of ECG-gated myocardial SPECT. Dyssynchrony was described with phase histogram bandwidth (PHBW), standard deviation (PHSD) or entropy (PHE) values above limit of the highest normal. RESULTS Prevalence of LVMD was 29% in CAD patients. Size of the infarction scar and ischemia extent correlated significantly with PHBW, PHSD and PHE (P < 0.001 for all). Independent predictors of LVMD were myocardial infarction scar (P = 0.004), ischemia extent (P = 0.003), and QRS duration (P = 0.003). Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony. CONCLUSIONS Almost one-third of CAD patients had significant LVMD. Dyssynchrony was associated with earlier myocardial infarction and presence of myocardial ischemia. Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony.
Collapse
Affiliation(s)
- Hanna Hämäläinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland.
| | - Alisa Corovai
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Jussi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Marja Hedman
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
9
|
Iswandi CP, van den Berg VJ, Simsek S, van Velzen D, Boekel ET, Cornel JH, de Boer S, de Mulder M, Akkerhuis KM, Boersma E, Umans VA, Kardys I. IGF-1 is not related to long-term outcome in hyperglycemic acute coronary syndrome patients. Diab Vasc Dis Res 2021; 18:14791641211047436. [PMID: 34851758 PMCID: PMC8743970 DOI: 10.1177/14791641211047436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Insulin-like growth factor-1 (IGF-1) has been associated with both protective and detrimental effects on the development of ischemic heart disease. The relationship between IGF-1 levels and major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients remains unclear. This study aimed to investigate the relationship between IGF-1 admission levels in hyperglycemic ACS patients and: (1) MACE over a 5 years follow-up, (2) type 2 diabetes at discharge, and (3) post-ACS myocardial infarct size and dysfunction. METHODS This was a post hoc analysis of the BIOMArCS-2 randomized controlled trial. From July 2008 to February 2012, 276 ACS patients with admission plasma glucose level between 140 and 288 mg/dL were included. Records of the composite of all-cause mortality and recurrent non-fatal myocardial infarction were obtained during 5 years follow-up. Venous blood samples were collected on admission. IGF-1 was measured batchwise after study completion. Oral glucose tolerance test was performed to diagnose type 2 diabetes, whereas infarct size and left ventricular function were assessed by myocardial perfusion scintigraphy (MPS) imaging, 6 weeks post-ACS. RESULTS Cumulative incidence of MACE was 24% at 5 years follow-up. IGF-1 was not independently associated with MACE (HR:1.00 (95%CI:0.99-1.00), p = 0.29). Seventy-eight patients (28%) had type 2 diabetes at discharge, and the highest quartile of IGF-1 levels was associated with the lowest incidence of diabetes (HR:0.40 (95%CI:0.17-0.95), p = 0.037). IGF-1 levels were not associated with post-ACS myocardial infarct size and dysfunction. CONCLUSIONS IGF-1 carries potential for predicting type 2 diabetes, rather than long-term cardiovascular outcomes and post-ACS myocardial infarct size and dysfunction, in hyperglycemic ACS patients.
Collapse
Affiliation(s)
- Cindya P Iswandi
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Victor J van den Berg
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Daan van Velzen
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Edwin Ten Boekel
- Department of Clinical Chemistry, Northwest Clinics, Alkmaar, Netherlands
| | - Jan-Hein Cornel
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Sanneke de Boer
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Maarten de Mulder
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
10
|
Bazzy J, Gadiyaram V, Nguyen BJ, Birgersdotter-Green U, Hoh CK, Obrzut S. Gated single-photon emission computed tomography myocardial perfusion imaging phase analysis as an imaging biomarker for mortality prediction in heart failure patients undergoing cardiac resynchronization therapy. Nucl Med Commun 2021; 42:990-997. [PMID: 34001831 DOI: 10.1097/mnm.0000000000001426] [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: 11/26/2022]
Abstract
OBJECTIVE Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients. The purpose of this study was to assess the value of gated myocardial perfusion single-photon emission computed tomography (GMPS) phase analysis for predicting survival in heart failure patients undergoing CRT. METHODS This retrospective cohort study evaluated heart failure patients who underwent GMPS prior to CRT. Phase histogram bandwidth (PHB) and phase SD (PSD) were calculated using GMPS data. Cox proportional hazards model was used to identify independent predictors of overall survival (OS). RESULTS A total of 35 patients (age 65.1 ± 13.3, 27 men and 8 women), who were followed for mean of 4.1 ± 2.9 years, were enrolled in the study. PSD of greater than 45° was found to be an independent predictor of poor OS (hazard ratio = 12.63, P = 0.011) when compared with age (hazard ratio = 1.00, P = 0.922), gender (hazard ratio = 0.31, P = 0.155), NYHA class (hazard ratio = 0.45, P = 0.087), QRS duration greater than 150 ms (hazard ratio = 2.38, P = 0.401), pre-CRT left ventricular ejection fraction (LVEF) (hazard ratio = 0.95, P = 0.175) and etiology of heart failure (hazard ratio = 1.42, P = 0.641). Furthermore, PHB greater than 140° was also found to be an independent predictor of poor OS (hazard ratio = 5.63, P = 0.040) when compared with age, gender, NYHA class, QRS duration greater than 150 ms, pre-CRT LVEF and etiology of heart failure. CONCLUSIONS PSD and PHB, measured by GMPS, may serve as biomarkers for the prediction of survival in patients undergoing CRT.
Collapse
Affiliation(s)
| | | | | | | | - Carl K Hoh
- Division of Nuclear Medicine, University of California San Diego, San Diego, California, USA
| | - Sebastian Obrzut
- Division of Nuclear Medicine, University of California San Diego, San Diego, California, USA
| |
Collapse
|
11
|
Alexanderson-Rosas E, Espinola-Zavaleta N, Garcia EV, Peix A, Massardo T, Pabon LM, Antonio-Villa NE, Carvajal-Juarez I, Mesquita CT, Jimenez-Heffernan A, Patel C, Karthikeyan G, Kumar A, Butt S, Kalaivani M, Marin V, Morozova O, Paez D. Diastolic dyssynchrony assessment by gated myocardial perfusion-SPECT in subjects who underwent cardiac resynchronization therapy. J Nucl Cardiol 2021; 28:1413-1421. [PMID: 31410734 DOI: 10.1007/s12350-019-01845-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period. MATERIAL & METHODS Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°. RESULTS Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P < 0.001). LVDD was not associated with improvement in clinical outcomes at follow-up. CONCLUSION CRT improves both systolic and diastolic dyssynchrony values at 6-month follow-up. LVDD at baseline is correlated with cardiac functionality at follow-up, but not with overall favorable clinical outcomes.
Collapse
Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico.
- Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology, La Habana, Cuba
| | | | | | | | - Isabel Carvajal-Juarez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
| | | | | | - Chetan Patel
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Alka Kumar
- Dr. B L Kapur Memorial Hospital, New Delhi, India
| | - Sadaf Butt
- Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Mani Kalaivani
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|
12
|
Peix A, Padrón K, Cabrera LO, Pardo L, Sánchez J. Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries. J Nucl Cardiol 2021; 28:1055-1063. [PMID: 31267412 DOI: 10.1007/s12350-019-01804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To detect ischemia in patients with angina and normal coronaries frequently represents a complex diagnosis. METHODS To investigate whether left ventricular mechanical dyssynchrony by phase analysis contributes in the evaluation of patients with chest pain and normal coronaries, gated-SPECT myocardial perfusion imaging (MPI) at rest and 30 minutes post-stress was performed in 218 patients with normal epicardial coronaries, who were divided into two groups: those with summed difference score (SDS) ≥ 4 (54 patients, Group 1), and those with SDS < 4 (164 patients, Group 2). Intraventricular synchronism-phase standard deviation (PSD) and histogram bandwidth (HBW)-was evaluated by phase analysis. RESULTS Women were significantly more frequent in Group 2 (those without ischemia in SPECT MPI): 113 (69%) vs 25 (46%), P = .00001. In males, left ventricular ejection fraction (LVEF) and ventricular volumes were not significantly different between patients with or without ischemia. However, ischemic females showed significantly higher ventricular volumes, minor post-stress LVEF and more negative delta LVEF (- 3.9 vs 0.34, P = .0008) than the non-ischemic ones. There was a significant post-stress increase of PSD and HBW among males, although not among females. According to SSS (≥ 4, with ischemia/necrosis; < 4, without ischemia/necrosis), post-stress PSD and HBW significantly increase both in male and female, and PSD and HBW were significantly higher in females with SSS ≥ 4 compared to those with SSS < 4 (PSD rest: 19.04° vs 11.72°, P < .0001; HBW rest: 58.85° vs 38.21°, P < .0001). PSD and HBW were also higher among males with SSS ≥ 4 compared to those with SSS < 4, although not significantly. CONCLUSION Higher ventricular volumes in females and dyssynchrony are associated with inducible ischemia in MPI in patients with chest pain and normal coronaries. Stress-induced ischemia increases degree of dyssynchrony.
Collapse
Affiliation(s)
- Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba.
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba.
| | - Kenia Padrón
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Lázaro O Cabrera
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Leticia Pardo
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Jesús Sánchez
- Institute of Cybernetics, Mathematics and Physics, Havana, Cuba
| |
Collapse
|
13
|
de Souza Filho EM, Mesquita CT. Phase analysis of gated myocardial perfusion SPECT and cardiac resynchronization therapy: The good, the bad, and the ugly. J Nucl Cardiol 2021; 28:1136-1139. [PMID: 32043242 DOI: 10.1007/s12350-020-02056-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Erito Marques de Souza Filho
- Universidade Federal Fluminense, Post-Graduation in Cardiovascular Sciences Program, Niteroi, Brazil.
- Universidade Federal Rural do Rio de Janeiro, Nova Iguaçu, Brazil.
| | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense, EBESERH/Hospital Antonio Pedro, Niteroi, Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| |
Collapse
|
14
|
Ali O, Shenoy M, Alani A, Alani M, Williams K. Are SPECT MPI measures of dyssynchrony dyssynchronous? J Nucl Cardiol 2021; 28:1128-1135. [PMID: 31933153 DOI: 10.1007/s12350-019-02024-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assessment of left ventricular mechanical dyssynchrony (LVMD) from gated SPECT myocardial perfusion imaging (MPI) aims to aid selection of patients for cardiac resynchronization therapy (CRT), using either the standard deviation of left ventricular phase (PSD) ≥ 43° or phase histogram bandwidth (HBW) of > 38° and > 30.6° in males and females, respectively. We observed dyssynchrony parameters might be affected by test type and alignment. METHODS We reviewed 242 patients who underwent gated SPECT MPI with use of the Emory Cardiac Toolbox comparing PSD and HBW at rest and stress for Pearson correlation, and substitutability with Bland-Altman analysis. RESULTS There is statistically significant difference in the mean PSD and HBW during rest vs stress (33.4 ± 17.4° vs 20.7 ± 13.5° and 97.7 ± 59.6° vs 59.4 ± 45.4°, respectively, P < 0.001). Proper valve plane alignment rendered smaller values (i.e., less dyssynchrony) in both phase SD and HBW (16.8 ± 13.5) vs (22.2 ± 14.7) (P = 0.011), and (47.0 ± 38.2) vs (60.7 ± 48.0) (P = 0.023), respectively. CONCLUSION Proper alignment and test type, particularly low-dose rest vs high-dose stress, should be considered when assessing LVMD using SPECT MPI.
Collapse
Affiliation(s)
- Omaima Ali
- Department of Cardiology, Penn State Health Milton S Hershey Medical Center, Hershey, USA.
| | - Maithili Shenoy
- Department of Cardiology, Ascension St Vincent's Healthcare, Jacksonville, USA
| | - Anas Alani
- Department of Cardiology, University of California San Diego Medical Center Hillcrest, San Diego, USA
| | | | | |
Collapse
|
15
|
Slomka PJ, Moody JB, Miller RJH, Renaud JM, Ficaro EP, Garcia EV. Quantitative clinical nuclear cardiology, part 2: Evolving/emerging applications. J Nucl Cardiol 2021; 28:115-127. [PMID: 33067750 DOI: 10.1007/s12350-020-02337-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
Quantitative analysis has been applied extensively to image processing and interpretation in nuclear cardiology to improve disease diagnosis and risk stratification. This is Part 2 of a two-part continuing medical education article, which will review the potential clinical role for emerging quantitative analysis tools. The article will describe advanced methods for quantifying dyssynchrony, ventricular function and perfusion, and hybrid imaging analysis. This article discusses evolving methods to measure myocardial blood flow with positron emission tomography and single-photon emission computed tomography. Novel quantitative assessments of myocardial viability, microcalcification and in patients with cardiac sarcoidosis and cardiac amyloidosis will also be described. Lastly, we will review the potential role for artificial intelligence to improve image analysis, disease diagnosis, and risk prediction. The potential clinical role for all these novel techniques will be highlighted as well as methods to optimize their implementation.
Collapse
Affiliation(s)
- Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | - Robert J H Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| |
Collapse
|
16
|
Peix A, Karthikeyan G, Massardo T, Kalaivani M, Patel C, Pabon LM, Jiménez-Heffernan A, Alexanderson E, Butt S, Kumar A, Marin V, Mesquita CT, Morozova O, Paez D, Garcia EV. Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT). J Nucl Cardiol 2021; 28:55-64. [PMID: 30684258 PMCID: PMC7921049 DOI: 10.1007/s12350-018-01589-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/07/2018] [Indexed: 10/31/2022]
Abstract
BACKGROUND Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT. METHODS Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ). RESULTS Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28). CONCLUSION LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT.
Collapse
Affiliation(s)
- Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, La Habana, Cuba
| | | | | | - Mani Kalaivani
- All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Sadaf Butt
- Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Alka Kumar
- Dr. B L Kapur Memorial Hospital, New Delhi, India
| | | | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | | |
Collapse
|
17
|
Zhou Y, He Z, Liao S, Liu Y, Zhang L, Zhu X, Cheang I, Zhang H, Yao W, Li X, Zhou W. Prognostic value of integrative analysis of electrical and mechanical dyssynchrony in patients with acute heart failure. J Nucl Cardiol 2021; 28:140-149. [PMID: 33150533 PMCID: PMC10959237 DOI: 10.1007/s12350-020-02429-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony has been shown to provide significant clinical values for chronic heart failure (HF) and cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate whether electrical dyssynchrony combined with mechanical dyssynchrony has an incremental benefit over electrical dyssynchrony or mechanical dyssynchrony alone to predict clinical events in patients with acute heart failure (AHF). METHODS Ninety-six AHF patients who received standard 12-lead ECG, gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and echocardiography were enrolled. Thirty-two normal subjects were collected as the control group to get the normal database of mechanical dyssynchrony. The end point is the composite of all-cause death and heart transplantation. Electrical dyssynchrony was defined as QRS duration > 120 ms. Mechanical dyssynchrony was defined as > mean + 2 × SD phase standard deviation (PSD) or phase bandwidth (PBW) based on our normal database. RESULTS During the follow-up of 28 ± 10 months, complete data were obtained in 92 patients. 26 (28.3%) Patients who reached the end point were classified into the event group. There were no significant differences in PSD or PBW between the event and non-event groups. However, PBW > 77.76° was independently associated with the end point in the univariate and multivariate analysis (hazard ratio 2.92, 95% confidence interval 1.00-8.47, P = .049; hazard ratio 3.89, 95% confidence interval 1.01-14.97, P = .048). The Kaplan-Meier curve with a log-rank test showed that the end point rate was significantly higher in the patients with PBW > 77.76° (log-rank P = .039). Moreover, the ROC curve analysis showed that the area under the curve (AUC) for predicting end point events by the integrative analysis of QRS > 120 ms and PBW > 77.76° was significantly improved compared to QRS duration > 120 ms (AUC: 0.75 vs 0.68, P = .001) or PBW > 77.76° (AUC: 0.75 vs 0.62, P = .049), respectively. The model of combined electrical and mechanical dyssynchrony yielded a further significantly improved risk prediction for adverse events in the global χ2. CONCLUSIONS The combination of QRS duration > 120 ms and PBW > 77.76° was an independent predictor of all-cause death and heart transplantation in AHF patients. The integrative analysis of electrical and mechanical dyssynchrony provides incremental prognostic value for clinical use.
Collapse
Affiliation(s)
- Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
| | - Zhuo He
- College of Computing, Michigan Technological University, Houghton, MI, USA
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Yanyun Liu
- School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
| | - Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Weihua Zhou
- College of Computing, Michigan Technological University, Houghton, MI, USA
| |
Collapse
|
18
|
Shimizu M, Iiya M, Fujii H, Kimura S, Suzuki M, Nishizaki M. Left ventricular end-systolic contractile entropy can predict cardiac prognosis in patients with complete left bundle branch block. J Nucl Cardiol 2021; 28:162-171. [PMID: 31087265 DOI: 10.1007/s12350-019-01739-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Several patients with complete left bundle branch block (CLBBB) show left ventricular (LV) dyssynchrony and poor cardiac prognosis. However, the prognostic value of LV end-systolic contractile entropy which was measured by single-photon emission computer tomography (SPECT) has not been elucidated in patients with CLBBB. METHODS AND RESULTS We recruited consecutive 115 sinus-rhythm patients with CLBBB who underwent ECG-gated 201TlCl-SPECT. After 30 days of observation, finally 102 patients (75.2 ± 9.5 years, 62 male) were enrolled and observed retrospectively for a median of 671 days. Twenty-five patients fell into major cardiac events. Multivariate Cox regression analysis showed estimated glomerular filtration rate (eGFR) ≤ 39.35 mL/min and entropy ≥ 79% were significant and independent predictors for major cardiac events (hazard ratio: 4.256 and 7.587, P value = 0.006 and < 0.001, respectively). Machine learning (Random Forest method) revealed eGFR and entropy had higher feature importance than other predictors (0.140 and 0.138, respectively). Kaplan-Meyer curve analysis demonstrated that the group with entropy ≥ 79% and eGFR ≤ 39.36 mL/min had the worst cardiac prognosis (Logrank: P = 0.002). CONCLUSIONS Left ventricular end-systolic contractile entropy predicts poor cardiac prognosis in patients with CLBBB, which may be more valuable than the other parameters of SPECT.
Collapse
Affiliation(s)
- Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan.
| | - Munehiro Iiya
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Mitsuhiro Nishizaki
- Kanto Gakuin University/Odawara Cardiovascular Hospital, Yokohama/Odawara, Japan
| |
Collapse
|
19
|
Carrió I. Ernest V. Garcia, PhD (Born 1948). J Nucl Cardiol 2020; 27:1919-1922. [PMID: 32914321 DOI: 10.1007/s12350-020-02352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ignasi Carrió
- Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| |
Collapse
|
20
|
Pazhenkottil AP, Benz DC. New insights in the assessment of left ventricular dyssynchrony: Laying the foundations for phase analysis by cardiac SPECT. J Nucl Cardiol 2020; 27:2280-2282. [PMID: 30734218 DOI: 10.1007/s12350-019-01622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Aju P Pazhenkottil
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
| | - Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
21
|
Camilletti J, Erriest J, Espinola-Zavaleta N, Hernández-Sandoval S, Redolatti M, Cartasegna L, Arregui V, Vigo G, Alexanderson-Rosas E. Left ventricular dyssynchrony and abnormalities in wall motion, assessed by gated-SPECT as ischemic auxiliary markers. J Nucl Cardiol 2020; 27:2261-2268. [PMID: 30515745 DOI: 10.1007/s12350-018-01544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Left ventricular dyssynchrony (LVD) quantified by gated myocardial perfusion studies (MPS), through phase analysis (PA), has shown controversial results in myocardial stunning. OBJECTIVES Assessment of LVD and regional wall motion abnormalities (RWMA) in normal and ischemic patients. METHODS A cohort of 172 patients were studied. Summed Stress Score (SSS), Summed Resting Score (SRS), and Summed Difference Score (SDS) were evaluated. Group 1-patients with normal MPS (N = 133) and Group 2-patients with myocardial ischemia in the MPS (N = 39). LVD was evaluated through PA and RWM by visual analysis. RESULTS SSS 0 vs 9.8 ± 3.9 P = .0001; SDS 0 vs 9.8 ± 3.9 P = .0001; SRS 0 vs 0 P = NS, in G1 and G2. Significant differences were found in LVD between G1 and G2, bandwidth 36 ± 14 vs 63 ± 46 P = .0001; standard deviation 16 ± 10 vs 26 ± 15 P = .0001. In G1, 16% had LVD vs RWMA in 0%, P = .0001 and in G2, 59% with LVD vs 33% with RWMA, P = .03. Sensitivity for LVD 59% and for RWMA 33%, P = .03 and specificity for LVD 83% and for RWMA 100%, P = .0001. CONCLUSION Ischemic patients have LVD post-stress due to myocardial stunning. LVD measured by PA could be a useful tool to identify ischemia.
Collapse
Affiliation(s)
- Jorge Camilletti
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Juan Erriest
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Nilda Espinola-Zavaleta
- Departament of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No 1, Colonia Sección XVI, Del. Tlalpan, 14080, Mexico City, Mexico
| | - Salvador Hernández-Sandoval
- Departament of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No 1, Colonia Sección XVI, Del. Tlalpan, 14080, Mexico City, Mexico
| | - Mónica Redolatti
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Luis Cartasegna
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Víctor Arregui
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Gustavo Vigo
- Department of Nuclear Cardiology, Hospital Italiano de La Plata, La Plata, Argentina
| | - Erick Alexanderson-Rosas
- Departament of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No 1, Colonia Sección XVI, Del. Tlalpan, 14080, Mexico City, Mexico.
- Department of Physiology, Medicine Faculty, UNAM, Mexico City, Mexico.
| |
Collapse
|
22
|
Peix A, Padrón K, Cabrera LO, Castañeda O, Milán D, Castro J, Falcón R, Martínez F, Rodríguez L, Sánchez J, Mena E, Carrillo R, Fernández Y, Escarano R, Páez D, Dondi M. Intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results? EJNMMI Res 2020; 10:125. [PMID: 33079263 PMCID: PMC7575672 DOI: 10.1186/s13550-020-00703-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI).
Methods Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not significant. No significant differences were found at baseline regarding ventricular function, although end-systolic volume was slightly higher in LVNC CM patients. Mean SRS was significantly higher (p < 0.0001) in ischemic patients (14.9) versus non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were significantly more dyssynchronous: Their phase standard deviation (PSD) was higher (89.5° ± 14.2°) versus groups 2 (65.2° ± 23.3°) and 3 (69.7° ± 21.7°), p = 0.007. Although the quality of life significantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most significant intraventricular synchronism improvement: PSD was reduced from 89.5° ± 14.2° at baseline to 63.7° ± 20.5° post-CRT (p = 0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up. Conclusion CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.
Collapse
Affiliation(s)
- Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba.
| | - Kenia Padrón
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Lázaro O Cabrera
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Osmín Castañeda
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Danet Milán
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Jesús Castro
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Roylan Falcón
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Frank Martínez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Lydia Rodríguez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Jesús Sánchez
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Erick Mena
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Regla Carrillo
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Yoel Fernández
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Ricardo Escarano
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, 17 #702, Vedado, 10 400, La Habana, Cuba
| | - Diana Páez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|
23
|
Slomka PJ, Moody JB, Miller RJH, Renaud JM, Ficaro EP, Garcia EV. Quantitative clinical nuclear cardiology, part 2: Evolving/emerging applications. J Nucl Med 2020; 62:168-176. [PMID: 33067339 DOI: 10.2967/jnumed.120.242537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 01/15/2023] Open
Abstract
Quantitative analysis has been applied extensively to image processing and interpretation in nuclear cardiology to improve disease diagnosis and risk stratification. This is Part 2 of a two-part continuing medical education article, which will review the potential clinical role for emerging quantitative analysis tools. The article will describe advanced methods for quantifying dyssynchrony, ventricular function and perfusion, and hybrid imaging analysis. This article discusses evolving methods to measure myocardial blood flow with positron emission tomography and single-photon emission computed tomography. Novel quantitative assessments of myocardial viability, microcalcification and in patients with cardiac sarcoidosis and cardiac amyloidosis will also be described. Lastly, we will review the potential role for artificial intelligence to improve image analysis, disease diagnosis, and risk prediction. The potential clinical role for all these novel techniques will be highlighted as well as methods to optimize their implementation. (J Nucl Cardiol 2020).
Collapse
Affiliation(s)
- Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Robert J H Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI.,Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| |
Collapse
|
24
|
Malik D, Mittal BR, Sood A, Parmar M, Kaur K, Bahl A. Prognostic value of left ventricular mechanical dyssynchrony indices in long-standing type II diabetes mellitus with normal perfusion and left ventricular systolic functions on SPECT-MPI. J Nucl Cardiol 2020; 27:1640-1648. [PMID: 30209757 DOI: 10.1007/s12350-018-1436-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To test whether phase analysis indices from SPECT-MPI for left ventricular mechanical dyssynchrony (LVMD) are predictors of major adverse cardiac events (MACEs) in long-standing diabetes mellitus (DM). METHODS A total of 136 DM patients with normal perfusion and left ventricular systolic functions were followed up for about two years and divided into two groups according to the presence and the absence of MACEs. RESULT Thirteen (9.5%) patients experienced MACEs during follow-up. Patients experiencing MACEs showed significantly higher phase standard deviation (PSD) and wider phase bandwidth (PBW) than those who did not. Moreover, both PSD and PBW showed significant correlations (r = 0.25 and 0.27; P < 0.05) with duration of DM. Logistic regression analysis revealed significant associations of DM duration, microvascular complications, and LVMD indices for predicting MACEs. Kaplan-Meier event-free survival analysis revealed significantly higher rate of MACEs (Logrank = 10.02; P = 0.001) in patients with high PSD and wide PBW. An overall fit model consisting of high-PSD and wide-PBW group was improved with the addition of microvascular complications (χ2 = 15.9; P = 0.03) and further by addition of DM duration of ≥ 15 years (χ2 = 24.3; P = 0.007) as variables. CONCLUSION LVMD indices are novel prognostic markers in diabetic patients with normal perfusion and left ventricular systolic functions and their increases in magnitudes with DM-duration and in the presence of microvascular complications.
Collapse
Affiliation(s)
- Dharmender Malik
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Rai Mittal
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Madan Parmar
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Komalpreet Kaur
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Bahl
- Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
Hatta T, Yoda S, Hayase M, Monno K, Hori Y, Fujito H, Suzuki Y, Matsumoto N, Okumura Y. Prognostic Value of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology in Patients with Known or Suspected Stable Coronary Artery Disease with Preserved Left Ventricular Ejection Fraction. Int Heart J 2020; 61:685-694. [PMID: 32684598 DOI: 10.1536/ihj.20-008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).We retrospectively investigated 3,374 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI and had preserved LVEF (≥ 45%), and followed them up to confirm their prognosis for three years. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris, and severe heart failure requiring hospitalization. LV mechanical dyssynchrony was evaluated with phase analysis with the Heart Risk View-F software to obtain the phase bandwidth and standard deviation.During the follow-up, 179 patients experienced MCEs: cardiac death (n = 42); non-fatal MI (n = 34); unstable angina pectoris (n = 54); and severe heart failure (n = 49). Results of the multivariate analysis showed age, a history of MI, diabetes mellitus, summed stress score, and stress phase bandwidth to be independent predictors for MCEs. In Kaplan-Meier analysis, prognoses were significantly stratified with the tertiles of stress phase bandwidth.LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for predicting a prognosis and stratifying the risk of MCEs in Japanese patients with known or suspected stable CAD with preserved LVEF.
Collapse
Affiliation(s)
- Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine
| | - Koyuru Monno
- Department of Cardiology, Nihon University School of Medicine
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine
| | - Hidesato Fujito
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuo Okumura
- Department of Cardiology, Nihon University School of Medicine
| |
Collapse
|
27
|
Sillanmäki S, Aapro S, Lipponen JA, Tarvainen MP, Laitinen T, Hedman M, Hämäläinen H, Laitinen T. Electrical and mechanical dyssynchrony in patients with right bundle branch block. J Nucl Cardiol 2020; 27:621-630. [PMID: 30143955 DOI: 10.1007/s12350-018-1418-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Though fairly benign reputation, the right bundle branch block (RBBB) can cause left ventricular mechanical dyssynchrony (LVMD). Still, the relationship between electrical disturbance and LVMD is partly unclear among these patients. METHODS Thirty patients with RBBB and 60 matching controls were studied with vector electrocardiography and myocardial perfusion imaging phase analysis. RBBB group was divided into those with and those without LVMD. RESULTS Prevalence of LVMD among RBBB patients was 50% and among controls 22%. Odds ratio (OR) for LVMD in patients with RBBB vs controls without RBBB was 3.6 (95% CI 1.4 to 9.3). Ejection fraction (EF), end-systolic volume, the angle between QRS and T vectors, and the QRS angle in the sagittal plane were significantly different between RBBB patients with and without LVMD. The QRS duration was comparable in these groups. EF associated independently with LVMD, explaining 60% of its variation. A cut-off value of EF ≤ 55% detected LVMD in 100% specificity (sensitivity of 47%). CONCLUSION Half of the patients with RBBB had LVMD. The OR for LVMD between RBBB and normal ECG was 3.6. It seems that EF, rather than electrical parameters, is the main determinant of LVMD. This information might be useful when evaluating indications for cardiac resynchronization therapy.
Collapse
Affiliation(s)
- Saara Sillanmäki
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
- University of Eastern Finland, Kuopio, Finland.
| | - Sini Aapro
- University of Eastern Finland, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
28
|
Solodky A, Zafrir N. Electrical and mechanical dyssynchrony in patients with right bundle branch block. J Nucl Cardiol 2020; 27:631-633. [PMID: 30298370 DOI: 10.1007/s12350-018-1460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Alejandro Solodky
- Department of Cardiology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Nili Zafrir
- Department of Cardiology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel.
| |
Collapse
|
29
|
Lin WL, Wang SY, Shiau YC, Wu YW. The clinical usefulness of phase analysis in detecting coronary artery disease using dipyridamole thallium-201-gated myocardial perfusion imaging with a cadmium-zinc-telluride camera. J Nucl Cardiol 2020; 27:241-250. [PMID: 30171522 DOI: 10.1007/s12350-018-1417-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have demonstrated left ventricular mechanical dyssynchrony (LVMD) in patients with severe coronary artery disease (CAD) with ≥ 70% stenosis. The aim of this study was to evaluate the clinical usefulness of stress/rest LVMD in the diagnosis of CAD with ≥ 50% stenosis using dipyridamole thallium-201 (Tl-201) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera. METHODS AND RESULTS A total of 476 patients without known CAD who underwent dipyridamole Tl-201 MPI and coronary angiography within 6 months were retrospectively reviewed. LVMD parameters including phase standard deviation and phase histogram bandwidth, phase skewness and phase kurtosis, as well as myocardial perfusion and myocardial stunning were assessed in post-stress and rest MPI. Relationships between the presence of CAD on coronary angiography and single photon emission computerized tomography (SPECT) parameters were evaluated. The presence of perfusion abnormalities was the best diagnostic tool in detecting CAD. Although less left ventricular synchrony was observed post-stress in the CAD group compared to the non-CAD group, no significant dyssynchrony was noted. CONCLUSIONS The addition of phase analysis to help diagnose CAD in Tl-201-gated SPECT with dipyridamole stress may have limited value in patients with CAD with ≥ 50% stenosis.
Collapse
Affiliation(s)
- Wan-Ling Lin
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
| |
Collapse
|
30
|
Cardiac electrical and mechanical synchrony of super-responders to cardiac resynchronization therapy. Chin Med J (Engl) 2020; 133:141-147. [PMID: 31868806 PMCID: PMC7028186 DOI: 10.1097/cm9.0000000000000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Super-responders (SRs) to cardiac resynchronization therapy (CRT) regain near-normal or normal cardiac function. The extent of cardiac synchrony of SRs and whether continuous biventricular (BIV) pacing is needed remain unknown. The aim of this study was to evaluate the cardiac electrical and mechanical synchrony of SRs. METHODS We retrospectively analyzed CRT recipients between 2008 and 2016 in 2 centers to identify SRs, whose left ventricular (LV) ejection fraction was increased to ≥50% at follow-up. Cardiac synchrony was evaluated in intrinsic and BIV-paced rhythms. Electrical synchrony was estimated by QRS duration and LV mechanical synchrony by single-photon emission computed tomography myocardial perfusion imaging. RESULTS Seventeen SRs were included with LV ejection fraction increased from 33.0 ± 4.6% to 59.3 ± 6.3%. The intrinsic QRS duration after super-response was 148.8 ± 30.0 ms, significantly shorter than baseline (174.8 ± 11.9 ms, P = 0.004, t = -3.379) but longer than BIV-paced level (135.5 ± 16.7 ms, P = 0.042, t = 2.211). Intrinsic LV mechanical synchrony significantly improved after super-response (phase standard deviation [PSD], 51.1 ± 16.5° vs. 19.8 ± 8.1°, P < 0.001, t = 5.726; phase histogram bandwidth (PHB), 171.7 ± 64.2° vs. 60.5 ± 22.9°, P < 0.001, t = 5.376) but was inferior to BIV-paced synchrony (PSD, 19.8 ± 8.1° vs. 15.2 ± 6.4°, P = 0.005, t = 3.414; PHB, 60.5 ± 22.9° vs. 46.0 ± 16.3°, P = 0.009, t = 3.136). CONCLUSIONS SRs had significant improvements in cardiac electrical and LV mechanical synchrony. Since intrinsic synchrony of SRs was still inferior to BIV-paced rhythm, continued BIV pacing is needed to maintain longstanding and synchronized contraction.
Collapse
|
31
|
Barry O, Wang Y, Wahl G. Determination of baseline alveolar mucosa perfusion parameters using laser Doppler flowmetry and tissue spectrophotometry in healthy adults. Acta Odontol Scand 2020; 78:31-37. [PMID: 31349769 DOI: 10.1080/00016357.2019.1645353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To determine the baseline perfusion parameters of the alveolar mucosa using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS) in healthy adults.Material and methods: Forty-two healthy adult subjects of either sex were tested. The perfusion of the alveolar mucosa was evaluated using a laser Doppler flowmetry and tissue spectrophotometry using O2C 'oxygen to see' device. The measurements encompassed the maxillary and mandibular mucosa at 20 different points.Results: The O2C device is a reliable method for noninvasive measurement of different perfusion parameters of the oral mucosa. The hemoglobin saturation values (So2 in %), as well as relative amount of hemoglobin in arbitrary units (AU) of the maxillary mucosa demonstrated lower values of that in the mandible. The flow value (AU) exhibited a significant difference in the posterior molar region only, while the velocity value (AU) showed a significant difference across all points except for the anterior region.Conclusion: the present study provides a set of brand-new perfusion parameters of the microcirculation of the alveolar mucosa using LDF-TS. The study suggests a variation of the perfusion parameters between the maxilla and the mandible. Differences in the anatomy of the blood supply, the thickness of the mucosa and the cortical bone, may be attributed to this variation. Further studies using different probes and a combination of ultrasonic measurements and SDF imaging will aid in giving a better overview of the perfusion in the oral mucosa.
Collapse
Affiliation(s)
- Obada Barry
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Ying Wang
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Gerhard Wahl
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| |
Collapse
|
32
|
Malik D, Mittal BR, Sood A, Sharma A, Parmar M, Kaur K, Bahl A. Evaluation of left ventricular mechanical dyssynchrony with phase analysis in end-stage renal disease patients with normal gated SPECT-MPI. World J Nucl Med 2019; 18:238-243. [PMID: 31516366 PMCID: PMC6714158 DOI: 10.4103/wjnm.wjnm_49_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023] Open
Abstract
Phase analysis using gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is a relatively new tool for the assessment of ventricular synchrony. Hypertension, diabetes, renal diseases, and dyslipidemia may affect the phase parameters though their impact is not well understood. The present study aimed to evaluate the incidence of the left ventricular mechanical dyssynchrony (LVMD) in end-stage renal disease (ESRD) patients with normal gated SPECT-MPI and QRS duration (<120 ms) on electrocardiogram. Data of 129 patients (86 males) referred for gated SPECT-MPI for their pretransplant evaluation with normal gated stress SPECT-MPI (SSS <3 and ejection fraction ≥50%) were included in the study analysis. Documented clinical history along with confounding factors such as hypertension, dyslipidemia, smoking, and alcoholism were evaluated. Left ventricle functional (end-diastolic, end-systolic, and LV myocardial volume) and phase parameters (phase standard deviation [PSD], phase bandwidth [PBW] and entropy) were calculated using the QPS-QGS program. LVMD was noted in 36 (28%) of ESRD patients with normal QRS duration and gated SPECT-MPI. The mean attenuated corrected LV myocardial volume, ejection fraction, mean PSD, and PBW values were 84.3 ± 38.1 ml, 65.3 ± 13.5%, 9.8° ± 3.9°, and 61.4° ± 24.7°, respectively. The LV myocardial volume shows statistically significant correlation with the phase parameters (r = 0.31-0.47; P < 0.001). LVMD is present in a significant number of ESRD patients, and its extent is more with increase in LV myocardial volume. It may have an additional role in risk-stratification for cardiovascular disease in ESRD patients.
Collapse
Affiliation(s)
| | | | - Ashwani Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - Ashish Sharma
- Department of Renal Surgery, PGIMER, Chandigarh, India
| | - Madan Parmar
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | | | - Ajay Bahl
- Department of Cardiology, PGIMER, Chandigarh, India
| |
Collapse
|
33
|
Zhou Y, Li D, Tang H, Xu Y, Wang C, Jiang Z, Xu F, Zhao Z, Li C, Tang S, Tang L, Zhou W. Development and validation of a new method to diagnose apical hypertrophic cardiomyopathy by gated single-photon emission computed tomography myocardial perfusion imaging. Nucl Med Commun 2019; 40:206-211. [PMID: 30570518 PMCID: PMC10961109 DOI: 10.1097/mnm.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM The aim of this study is to develop and validate a new method to diagnose apical hypertrophic cardiomyopathy (AHCM) by the integral quantitative analysis of myocardial perfusion and wall thickening from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). PATIENTS AND METHODS Twenty-two consecutive patients, who showed T wave inversion of at least 3 mm in precordial leads and sinus rhythm in ECG, were enrolled. All the patients underwent cardiac magnetic resonance (CMR), gated rest SPECT MPI and echocardiography. According to CMR diagnostic results, 13 patients were categorized as in the AHCM group and the remaining nine patients were categorized as in the non-AHCM group. Operators who were blinded to the CMR diagnosis independently performed the diagnosis by gated SPECT MPI. The regions of interest inside the apical hotspots on the perfusion polar map were drawn and the mean values of wall thickening in the drawn region of interests were calculated. Using MRI diagnosis as the gold standard, AHCM was diagnosed based on receiver operating characteristic analysis of the mean wall thickening in the apical perfusion hotspot. The area under curve, sensitivity, specificity, and accuracy of our method were 0.97, 100%, 89%, and 95%, respectively. CONCLUSION Our new method has high sensitivity, specificity, and accuracy against CMR diagnosis. It has great promise to become a clinical tool in the diagnosis of AHCM.
Collapse
Affiliation(s)
- Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Zhongqiang Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Chunxiang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Shaojie Tang
- School of Automation, Xi’an University of Posts and Telecommunications, Xi’an, China
| | - Lijun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
| |
Collapse
|
34
|
Nakajima K, Okuda K, Matsuo S, Slomka P. Making the invisible visible: Phase dyssynchrony has potential as a new prognostic marker. J Nucl Cardiol 2019; 26:298-302. [PMID: 28547670 DOI: 10.1007/s12350-017-0929-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
- Department of Nuclear Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kahoku, Uchinada, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Piotr Slomka
- AIM Program/Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, USA
| |
Collapse
|
35
|
Benz DC, Pazhenkottil AP. Cardiac resynchronization therapy in chronic heart failure: Effect on right ventricular function. J Nucl Cardiol 2019; 26:133-135. [PMID: 28660601 DOI: 10.1007/s12350-017-0953-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| |
Collapse
|
36
|
Iiya M, Shimizu M, Fujii H, Suzuki M, Nishizaki M. True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single-photon emission computed tomography. J Arrhythm 2019; 35:70-78. [PMID: 30805046 PMCID: PMC6373645 DOI: 10.1002/joa3.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/02/2018] [Accepted: 11/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Conventional complete left bundle branch block (CLBBB) criteria sometimes result in a false-positive diagnosis that does not represent dyssynchrony. Recently, true CLBBB criteria have been proposed to detect responders to cardiac resynchronization therapy (CRT), although their correlation with severity of dyssynchrony or natural prognosis is unclear. METHODS Ninety-four consecutive patients (74 ± 9 years, 63 men) with conventional CLBBB during sinus rhythm underwent semiconductor SPECT. They were divided into two groups: patients with true CLBBB and others. True CLBBB was characterized by the mid-QRS notching/slurring and wide QRS duration (male, ≥140 milliseconds; female, ≥130 milliseconds). Multivariate analysis was performed to detect left ventricular dyssynchrony (LVD), defined as bandwidth ≥145° and/or phase standard deviation (SD) ≥43°. Primary endpoints (hospitalization for heart failure or cardiac death) were evaluated. RESULTS True CLBBB had wider bandwidth (145 ± 83° vs 110 ± 64°, P = 0.024) and higher phase SD (48 ± 26° vs 35 ± 19°, P = 0.007). Ejection fraction (EF), end-diastolic volume (EDV), summed rest score (SRS), and the presence of ischemic heart disease (IHD) showed no differences between groups (P = 0.401, 0.591, 0.165, and 0.212, respectively). Multivariate analysis revealed that true CLBBB, EF, and EDV were significant predictors of LVD (odds ratio, 12.6, 0.90, 1.03; P = 0.003, 0.002, 0.022, respectively). At 3-year follow-up (median 667 days), primary endpoints were comparable in both groups (log-rank, P = 0.92). CONCLUSIONS Patients with true CLBBB had more severe dyssynchrony on single-photon emission computed tomography than patients with nontrue CLBBB. On the other hand, the two groups showed no differences in EF, EDV, the presence of IHD, hospitalization for heart failure, and cardiac death.
Collapse
Affiliation(s)
- Munehiro Iiya
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | - Masato Shimizu
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | - Hiroyuki Fujii
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | - Makoto Suzuki
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | | |
Collapse
|
37
|
Mori H, Isobe S, Suzuki S, Unno K, Morimoto R, Kano N, Okumura T, Yasuda Y, Kato K, Murohara T. Prognostic value of left ventricular dyssynchrony evaluated by gated myocardial perfusion imaging in patients with chronic kidney disease and normal perfusion defect scores. J Nucl Cardiol 2019; 26:288-297. [PMID: 28432673 DOI: 10.1007/s12350-017-0889-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to investigate whether indices of left ventricular (LV) dyssynchrony by gated myocardial perfusion SPECT (GMPS) could be useful to predict prognosis in chronic kidney disease (CKD) patients with normal perfusion defect scores. METHODS One hundred and sixty-seven CKD patients with normal perfusion defect scores on adenosine-stress 201Tl GMPS and no previous history of overt heart diseases were enrolled. Phase standard deviation (PSD) and bandwidth (BW) were automatically calculated from GMPS. The major adverse cardiac events (MACEs) for a mean of 560 days were defined as sudden cardiac death, fatal arrhythmias, and acute coronary syndrome requiring urgent coronary revascularization. Patients were divided into two groups according to the presence or absence of MACEs. RESULTS The MACEs occurred in 12 patients (7.1%). Patients who experienced MACEs showed significantly higher PSD and wider BW than those who did not. In the Kaplan-Meier event-free survival analysis, cardiac event rate was significantly higher in the high-PSD and wide-BW group (n = 81) than in the low-PSD and narrow-BW group (n = 71) (P = .002). The multivariate regression analysis revealed that the PSD was associated with MACEs (odds ratio 1.33, 95% confidence interval 1.05-1.69, P = .01). CONCLUSION The LV dyssynchrony indices from GMPS may be novel prognostic predictors in CKD patients with normal perfusion defect scores.
Collapse
Affiliation(s)
- Hiroaki Mori
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Isobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazumasa Unno
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Katsuhiko Kato
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
38
|
Sassone B, Nucifora G, Mele D, Valzania C, Bisignani G, Boriani G. Role of cardiovascular imaging in cardiac resynchronization therapy: a literature review. J Cardiovasc Med (Hagerstown) 2018; 19:211-222. [PMID: 29470248 DOI: 10.2459/jcm.0000000000000635] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Cardiac resynchronization therapy (CRT) is an established treatment in patients with symptomatic drug-refractory heart failure and broad QRS complex on the surface ECG. Despite the presence of either mechanical dyssynchrony or viable myocardium at the site where delivering left ventricular pacing being necessary conditions for a successful CRT, their direct assessment by techniques of cardiovascular imaging, though feasible, is not recommended in clinical practice by the current guidelines. Indeed, even though there is growing body of data providing evidence of the additional value of an image-based approach as compared with routine approach in improving response to CRT, these results should be confirmed in prospective and large multicentre trials before their impact on CRT guidelines is considered.
Collapse
Affiliation(s)
- Biagio Sassone
- Department of Cardiology, SS.ma Annunziata Hospital.,Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - Gaetano Nucifora
- Cardiology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Flinders University, Adelaide, Australia
| | - Donato Mele
- Noninvasive Cardiology Unit, University Hospital of Ferrara, Ferrara
| | - Cinzia Valzania
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | | |
Collapse
|
39
|
Naya M, Manabe O, Koyanagawa K, Tamaki N. The role of nuclear medicine in assessments of cardiac dyssynchrony. J Nucl Cardiol 2018; 25:1980-1987. [PMID: 28956317 DOI: 10.1007/s12350-017-1072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022]
Abstract
Radionuclide imaging has an advantage for quantitative analyses of the tracer concentration and its temporal changes. Myocardial perfusion and function have been adapted for synchrony analyses. Extracted parameters have been demonstrated to measure ventricular synchrony and even to predict CRT outcomes. ERNA has the advantages of higher temporal resolution, greater reproducibility, and the volumetric analysis of both ventricles that can be applied for analyses of intraventricular synchrony and interventricular synchrony. Several software packages such as Quantitative Gated SPECT, the Emory Cardiac Toolbox, cardioREPO, and Heart Function View are available to assess the LV dyssynchrony parameters from GSPECT. A count-based method is applied to extract the amplitude and phase from each of the reconstructed GSPECT short-axis datasets throughout the cardiac cycle and then subjected to a Fourier analysis, the results of which are displayed on a polar map and histogram. Some of the parameters such as the bandwidth (expressed as the 95% width of the phase histogram) and the standard deviation of the phase are obtained by the phase histogram to assess the intraventricular synchrony. This review paper focuses on the application of the LV dyssynchrony parameters estimated by cardiac SPECT in patients with a heart disease.
Collapse
Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
40
|
Zhou W, Hung GU. Left-ventricular mechanical dyssynchrony in the prognosis of dilated cardiomyopathy: Which parameter is more useful? J Nucl Cardiol 2018; 25:1688-1691. [PMID: 28361476 DOI: 10.1007/s12350-017-0863-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA.
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.
| |
Collapse
|
41
|
Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25:1784-1846. [PMID: 29802599 DOI: 10.1007/s12350-018-1283-y] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Andrew J Einstein
- Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Thomas A Holly
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John J Mahmarian
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | | | - Donna M Polk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
| |
Collapse
|
42
|
Zafrir N. Left ventricular mechanical dyssynchrony graduation of myocardial perfusion gated SPECT phase analysis: What next. J Nucl Cardiol 2018; 25:1009-1011. [PMID: 27826774 DOI: 10.1007/s12350-016-0717-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Nili Zafrir
- Cardiology Department, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Predictive and prognostic value of left ventricular mechanical dyssynchrony assessed by myocardial perfusion single photon emission computed tomography in asymptomatic patients under hemodialysis. Nucl Med Commun 2018; 39:423-429. [DOI: 10.1097/mnm.0000000000000816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Lee R, Shah RV, Murthy VL. Assessment of dyssynchrony by gated myocardial perfusion imaging does not improve patient management. J Nucl Cardiol 2018; 25:526-531. [PMID: 28791621 PMCID: PMC6312556 DOI: 10.1007/s12350-017-1022-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
Clinical trials have demonstrated improved outcomes with cardiac resynchronization therapy in patients with heart failure and electrical evidence of dyssynchrony. There has been intense effort at developing imaging markers of dyssynchrony with the aim of improved risk stratification. However, these efforts have not been fruitful to date. This article discusses mechanisms of cardiac dyssynchrony, reviews clinical data supporting resynchronization therapy, and addresses the lack of convincing evidence to support the use of noninvasive imaging measures of dyssynchrony in improving patient management.
Collapse
Affiliation(s)
- Ran Lee
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA.
| | - Ravi V Shah
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA
| |
Collapse
|
46
|
Mechanical dyssynchrony and diastolic dysfunction are common in LVH: a pilot correlation study using Doppler echocardiography and CZT gated-SPECT MPI. Sci Rep 2018. [PMID: 29520004 PMCID: PMC5843584 DOI: 10.1038/s41598-018-22213-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an often under-diagnosed cause of left ventricular hypertrophy (LVH). It affects 1/500 of the population, is the most commonly inherited cardiovascular disorder, and can present in apical, concentric, or septal forms. Although most patients are asymptomatic, sudden cardiac death can be the initial presentation of HCM. By retrospectively enrolling patients suspected of having three different types of HCM in the absence of epicardial coronary stenosis, we aimed to examine systolic and diastolic dysfunction and perfusion abnormalities using both Doppler echocardiography and state-of-the-art gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera and thallium-201. Both regional perfusion and gated SPECT parameters were collected in addition to diastolic parameters from Doppler echocardiography. The results showed that mild ischemia was common in patients suspected of having HCM, with a mean summed stress score of 4.7 ± 4.9 (score 0–4 in 17-segment model). The patients with HCM were associated with discernible left ventricular mechanical dyssynchrony, especially those with the apical form. In addition, diastolic dysfunction was prevalent and early to late ventricular filling velocity ratios were significantly different between groups. By combining gated-MPI and Doppler data, the trivial functional changes in HCM may be identified.
Collapse
|
47
|
Li K, Qian Z, Hou X, Wang Y, Qiu Y, Sheng Y, Qian X, Zhou Y, Zou J. The incidence and outcomes of delayed response to cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:73-80. [PMID: 29222875 DOI: 10.1111/pace.13252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/05/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence and clinical outcomes of delayed response to cardiac resynchronization therapy (CRT) have not been well clarified. We aimed to observe the incidence and prognosis of delayed response and to identify its possible mechanisms. METHODS A total of 115 CRT patients were retrospectively analyzed in our study. Patients who met the enrollment criteria were divided into two groups: group A, conventional responders who showed response at 1-year follow-up, and group B, delayed responders who showed response after 1-year follow-up. CRT response was defined as an absolute increase of ≥10% in left ventricular ejection fraction. RESULTS Fifty-two patients (61 ± 12 years, 37 male) experienced conventional response to CRT and 17 patients (63 ± 11 years, 10 male) experienced delayed response. The mean follow-up time was 5.2 ± 2.4 years. The incidence of delayed response was 14.8% (17/115). All-cause mortality and hospitalization rates for heart failure were similar for delayed and conventional responders. Multivariate logistic regression analysis revealed that scar burden > 35% was an independent predictor of CRT delayed response (odds ratio 8.794, P = 0.038). CONCLUSIONS A significant proportion of patients demonstrated delayed response to CRT. The delayed responders had a good prognosis that was similar to that of conventional responders. More scar burden might be related to the incidence of delayed response.
Collapse
Affiliation(s)
- Kebei Li
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Cardiology, The First People's Hospital of Zhangjiagang, Affiliated Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Zhiyong Qian
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanhao Qiu
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yufeng Sheng
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Affiliated Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Xuesong Qian
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Affiliated Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Yong Zhou
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Affiliated Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Jiangang Zou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
48
|
Massardo T, Alarcón L, Spuler J. Estratificación de riesgo de enfermedad coronaria con métodos isotópicos. Estado actual de la práctica clínica. Rev Esp Med Nucl Imagen Mol 2017; 36:377-387. [DOI: 10.1016/j.remn.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
|
49
|
Massardo T, Alarcón L, Spuler J. Risk stratification of coronary artery disease using radionuclides. Current status of clinical practice. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Zhou W, Jiang Z, Chen J, Garcia EV, Li D. Development and validation of a phase analysis tool to measure interventricular mechanical dyssynchrony from gated SPECT MPI. J Nucl Cardiol 2017; 24:1680-1686. [PMID: 27225514 PMCID: PMC10955150 DOI: 10.1007/s12350-016-0503-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study is to develop a right-ventricular (RV) phase analysis tool which when coupled with our left ventricular (LV) phase analysis tool can provide measurement of the interventricular mechanical dyssynchrony from gated SPECT myocardial perfusion imaging (MPI), and validate the tool by electrocardiography (ECG). METHODS For each patient, short-axis LV and RV SPECT MPI images were input into an automatic sampling algorithm to generate the 3D maximal count circumferential profiles for both LV and RV in each cardiac frame. Subsequently, the samples of LV and RV were separately used by our phase analysis tool based on the first-harmonic Fourier approximation to calculate the contraction onset for each sample. The difference between contraction onsets of the middle LV free wall and middle LV septal wall represented the LV contraction delay; the difference between contraction onsets of the middle RV free wall and middle RV septal wall represented the RV contraction delay. The difference between the LV and RV contraction delays represented the interventricular contraction delay, which was compared with the interventricular conduction delay classified by ECG to validate the concordance of interventricular mechanical and electrical dyssynchrony. Sixty-one bundle branch block (BBB) patients with ischemic-dilated cardiomyopathy (26, 42.6%) or non-ischemic-dilated cardiomyopathy (35, 57.4%), who underwent 12-lead surface ECG and gated resting Tc-99m sestamibi SPECT, were retrospectively analyzed in this study. RESULTS In the 30 patients with left bundle branch block (LBBB) by ECG, there were 27 patients whose LV contracted later than the RV according to SPECT; and in the 31 patients with right bundle branch block (RBBB) by ECG, there were 26 patients whose LV contracted earlier than the RV according to SPECT. In total, an agreement rate of 86.9% (53 of 61) was achieved between SPECT and ECG. The Kappa agreement rate was 73.8% (95% confidence interval 0.57-0.91). CONCLUSION The preliminary results showed promise for the measurement of interventricular mechanical dyssynchrony in BBB patients with dilated cardiomyopathy using our phase analysis tool.
Collapse
Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|