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do Nascimento EA, Fernandes FDA, Mira PAC, He Z, Zhou W, Mesquita CT. Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling. Arq Bras Cardiol 2023; 120:e20220077. [PMID: 37018787 PMCID: PMC10392842 DOI: 10.36660/abc.20220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/25/2022] [Accepted: 11/23/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). OBJECTIVE The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. METHODS Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. RESULTS At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. CONCLUSIONS LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.
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Affiliation(s)
- Erivelton Alessandro do Nascimento
- Universidade Federal FluminenseHospital Universitário Antônio PedroPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Serviço de Cardiologia, Hospital Universitário Antônio Pedro e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
- Instituto Estadual de Cardiologia Aloysio de CastroDepartamento de Arritmias CardíacasRio de JaneiroRJBrasilInstituto Estadual de Cardiologia Aloysio de Castro – Departamento de Arritmias Cardíacas, Rio de Janeiro, RJ – Brasil
| | - Fernando de Amorim Fernandes
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
| | - Pedro Augusto Carvalho Mira
- Universidade Federal FluminenseLaboratório de Ciências do ExercícioNiteróiRJBrasilUniversidade Federal Fluminense – Laboratório de Ciências do Exercício, Niterói, RJ – Brasil
| | - Zhuo He
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Weihua Zhou
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Claudio Tinoco Mesquita
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
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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
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Jimenez-Heffernan A, Butt S, Mesquita CT, Massardo T, Peix A, Kumar A, Patel C, Alexanderson E, Pabon LM, Karthikeyan G, Gutierrez C, Marin V, Garcia E, Paez D. Technical aspects of gated SPECT MPI assessment of left ventricular dyssynchrony used in the VISION-CRT study. J Nucl Cardiol 2021; 28:1165-1171. [PMID: 32394405 PMCID: PMC8249285 DOI: 10.1007/s12350-020-02122-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/16/2020] [Indexed: 11/13/2022]
Affiliation(s)
| | - Sadaf Butt
- Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | | | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology, La Habana, Cuba
| | - Alka Kumar
- Dr. B L Kapur Memorial Hospital, New Delhi, India
| | - Chetan Patel
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
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Kortelainen MJ, Koivumäki TM, Vauhkonen MJ, Hakulinen MA. Time-modified OSEM algorithm for more robust assessment of left ventricular dyssynchrony with phase analysis in ECG-gated myocardial perfusion SPECT. EJNMMI Phys 2019; 6:30. [PMID: 31883051 PMCID: PMC6934641 DOI: 10.1186/s40658-019-0261-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background In ordered subsets expectation maximization (OSEM) reconstruction of electrocardiography (ECG)-gated myocardial perfusion single-photon emission computed tomography (SPECT), it is often assumed that the image acquisition time is constant for each projection angle and ECG bin. Due to heart rate variability (HRV), this assumption may lead to errors in quantification of left ventricular mechanical dyssynchrony with phase analysis. We hypothesize that a time-modified OSEM (TOSEM) algorithm provides more robust results. Methods List-mode data of 44 patients were acquired with a dual-detector SPECT/CT system and binned to eight ECG bins. First, activity ratio (AR)—the ratio of total activity in the last OSEM-reconstructed ECG bin and first five ECG bins—was computed, as well as standard deviation SDR-R of the accepted R–R intervals; their association was evaluated with Pearson correlation analysis. Subsequently, patients whose AR was higher than 90% were selected, and their list-mode data were rebinned by omitting a part of the acquired counts to yield AR values of 90%, 80%, 70%, 60% and 50%. These data sets were reconstructed with OSEM and TOSEM algorithms, and phase analysis was performed. Reliability of both algorithms was assessed by computing concordance correlation coefficients (CCCs) between the 90% data and data corresponding to lower AR values. Finally, phase analysis results assessed from OSEM- and TOSEM-reconstructed images were compared. Results A strong negative correlation (r = -0.749) was found between SDR-R and AR. As AR decreased, phase analysis parameters obtained from OSEM images decreased significantly. On the contrary, reduction of AR had no significant effect on phase analysis parameters obtained from TOSEM images (CCC > 0.88). The magnitude of difference between OSEM and TOSEM results increased as AR decreased. Conclusions TOSEM algorithm minimizes the HRV-related error and can be used to provide more robust phase analysis results.
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Affiliation(s)
- Matti J Kortelainen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland. .,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Tuomas M Koivumäki
- Department of Medical Physics, Central Finland Central Hospital, Jyväskylä, Finland
| | - Marko J Vauhkonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - Mikko A Hakulinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Juarez-Orozco LE, Monroy-Gonzalez A, Prakken NHJ, Noordzij W, Knuuti J, deKemp RA, Slart RHJA. Phase analysis of gated PET in the evaluation of mechanical ventricular synchrony: A narrative overview. J Nucl Cardiol 2019; 26:1904-1913. [PMID: 30834496 PMCID: PMC6908565 DOI: 10.1007/s12350-019-01670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022]
Abstract
Noninvasive imaging modalities offer the possibility to dynamically evaluate cardiac motion during the cardiac cycle by means of ECG-gated acquisitions. Such motion characterization along with orientation, segmentation preprocessing, and ultimately, phase analysis, can provide quantitative estimates of ventricular mechanical synchrony. Current evidence on the role of mechanical synchrony evaluation is mainly available for echocardiography and gated single-photon emission computed tomography, but less is known about the utilization of gated positron emission tomography (PET). Although data available are sparse, there is indication that mechanical synchrony evaluation can be of diagnostic and prognostic values in patients with known or suspected coronary artery disease-related myocardial ischemia, prediction of response to cardiac resynchronization therapy, and estimation of risk for adverse cardiac events in patients' heart failure. As such, the evaluation of mechanical ventricular synchrony through phase analysis of gated acquisitions represents a value addition to modern cardiac PET imaging modality, which warrants further research and development in the evaluation of patients with cardiovascular disease.
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Affiliation(s)
- Luis Eduardo Juarez-Orozco
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Andrea Monroy-Gonzalez
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Niek H J Prakken
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute (UOHI), University of Ottawa, Ottawa, ON, Canada
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
- Biomedical Photonic Imaging, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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Malhotra S. Assessment of ventricular synchrony by positron emission tomography: With great power comes great responsibility. J Nucl Cardiol 2019; 26:1914-1917. [PMID: 30980337 DOI: 10.1007/s12350-019-01714-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush Medical College, Chicago, IL, USA.
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Malhotra S, Pasupula DK, Sharma RK, Saba S, Soman P. Relationship between left ventricular dyssynchrony and scar burden in the genesis of ventricular tachyarrhythmia. J Nucl Cardiol 2018; 25:555-569. [PMID: 29110290 DOI: 10.1007/s12350-017-1095-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (EF) has poor predictive value for ventricular tachyarrhythmia (VT). Other parameters such as LV dyssynchrony (LVD), and LV scar burden have also been individually associated with VT, but the interplay of these factors in the genesis of VT has not been explored. This retrospective study sought to evaluate the relationship between LVD and imaging characteristics of the myocardial substrate in predicting VT. METHODS We identified 183 patients (150 men; mean age: 64 ± 14 years and mean LVEF: 23% ± 7%), who received an implantable cardioverter defibrillator (ICD) for primary prevention and who underwent a gated single-photon emission computed tomography (GSPECT) myocardial perfusion scan prior to ICD implantation. LVD was determined by phase analysis of the GSPECT images. Occurrence of VTs was established through routine ICD interrogations and review of electronic medical records. RESULTS LVD was present in 136 (74%) patients. VT occurred in 48 (26%) patients. Ninety-eight percent of patient who experienced VT had LVD. Patients without LVD had a significantly better survival free of both sustained and non-sustained VT (HR, 95% CI 4.90, 2.12-11.20; P < 0.0001). The combination of LVD and myocardial scar occupying > 6% of LV myocardium accounted for 83% of all VT events. CONCLUSIONS LVD assessment by GSPECT is strongly associated with incident VT in patients with low LVEF. The combination of LVD and scar burden predicted the majority of VT events.
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Affiliation(s)
- Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Deepak K Pasupula
- Department of Internal Medicine, University of Pittsburgh Medical Center at McKeesport, McKeesport, PA, USA
| | - Ravi K Sharma
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samir Saba
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Folks RD, Cooke CD, Garcia EV. Optimizing gated myocardial perfusion imaging processing for phase analysis. J Nucl Cardiol 2016; 23:1348-1354. [PMID: 27225515 DOI: 10.1007/s12350-016-0543-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Russell D Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Comparison between a count-based and geometrical approach for the assessment of left ventricular dyssynchrony using myocardial perfusion scintigraphy. Nucl Med Commun 2016; 37:1125-35. [PMID: 27383191 DOI: 10.1097/mnm.0000000000000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are two distinct approaches for the assessment of left ventricular (LV) dyssynchrony by myocardial perfusion scintigraphy (MPS). The aim of this study was to compare the performance of the count-based and geometrical approach in clinical data using gated single photon emission computed tomography MPS. MATERIAL AND METHODS Group 1 consisted of 113 patients (49 men, 64 women) with normal perfusion [summed rest score (SRS)≤3], normal LV ejection fraction (≥55%), and normal QRS duration (QRSd<120 ms). Group 2 consisted of 89 heart failure patients (79 men, 10 women) with no restriction for SRS, LV ejection fraction ≤35%, and QRSd ≥120 ms. All MPS parameters were obtained from the software Corridor4DM. Dyssynchrony parameters used were time to peak contraction, SD, and bandwidth (BW). RESULTS SD and BW were estimated higher (difference group 1: SD 3.0±2.3 and BW 11.3±9.3, P-values <0.001; difference group 2: SD 2.4±4.3 and BW 1.3±17.0, P-value <0.001 and 0.479 respectively) using the count-based approach in comparison with the geometrical method. A significant and good correlation was found between these two methods (R=0.763, 0.902, 0.896 for time to peak contraction, SD, and BW respectively, P-values ≤0.001). SD and BW in both approaches were equally good parameters for differentiating heart failure patients (area under the curve: 0.995-0.998), although using different cut-off values. CONCLUSION The count-based approach generally provides a wider phase distribution and subsequently greater SD and BW estimates compared with the geometrical algorithm. These differences result in clinically relevant deviations in normal and cut-off values that have to be recognized when evaluating patients.
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Kortelainen MJ, Koivumäki TM, Vauhkonen MJ, Hakulinen MA. Dependence of left ventricular functional parameters on image acquisition time in cardiac-gated myocardial perfusion SPECT. J Nucl Cardiol 2015; 22:643-51. [PMID: 26048265 DOI: 10.1007/s12350-015-0178-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reduction of image acquisition time in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) examinations has been considered. However, association between left ventricular (LV) functional parameters and acquisition time is unclear. METHODS Twenty-four patients referred to one-day stress/rest SPECT MPI examinations were imaged at rest with dual-headed gamma camera. List-mode emission data were processed into sets of cardiac-gated images corresponding to different acquisition times: 20%, 30%, 40%, 50%, 60%, 80%, and 100% of total acquisition time (30 seconds per projection). Image quality was quantitatively evaluated by computing contrast-to-noise ratio. LV volumes, wall motion, wall thickening, and mechanical dyssynchrony were quantified with automatic clinical software (QGS; Cedars-Sinai Medical Center). RESULTS A significant negative dependence was found between phase analysis parameter values and image acquisition time. Differences in LV volume parameters were small but statistically significant at relative acquisition times of less than 50%. LV wall motion and wall thickening were found to be robust to the increase of noise. CONCLUSIONS Image acquisition time of gated SPECT MPI examination can be reduced to 15 seconds per projection without significantly affecting LV volumes, wall motion, or wall thickening. However, reduction of acquisition time has a significant effect on phase analysis results.
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Affiliation(s)
- Matti J Kortelainen
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland,
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Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA). Nucl Med Commun 2015; 35:818-23. [PMID: 24781009 PMCID: PMC4076031 DOI: 10.1097/mnm.0000000000000143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, 123I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease.
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Soman P, Chen J. Left ventricular dyssynchrony assessment using myocardial single-photon emission CT. Semin Nucl Med 2015; 44:314-9. [PMID: 24948153 DOI: 10.1053/j.semnuclmed.2014.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial SPECT using standard procedure for perfusion imaging and phase analysis is a novel approach to left ventricular dyssynchrony assessment. Preliminary data suggest excellent repeatability and potential utility for guiding cardiac resynchronization therapy and elucidating mechanisms.
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Affiliation(s)
- Prem Soman
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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Ludwig DR, Friehling M, Schelbert EB, Schwartzman D. Impact of scar on SPECT assay of left ventricular contraction dyssynchrony. Eur J Nucl Med Mol Imaging 2013; 41:529-35. [DOI: 10.1007/s00259-013-2608-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
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