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Zhang F, Wang J, Shao X, Xu M, Chen Y, Fan S, Shi Y, Liu B, Yu W, Li X, Xu M, Yang M, Xi X, Wu Z, Li S, Wang Y. Longitudinal evaluation of diastolic dyssynchrony by SPECT gated myocardial perfusion imaging early after acute myocardial infarction and the relationship with left ventricular remodeling progression in a swine model. J Nucl Cardiol 2022; 29:1520-1533. [PMID: 33506381 DOI: 10.1007/s12350-020-02483-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Left ventricular diastolic dyssynchrony (LVDD), a dyssynchronous relaxation pattern, has been known to develop after myocardial damage. We aimed to evaluate the dynamic changes in LVDD in the early stage of acute myocardial infarction (AMI) by phase analysis of 99mtechnetium methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) and explore its relationship with the progression of left ventricular remodeling (LVR). METHODS The left anterior descending coronary arteries of 16 Bama miniature swine were occluded with a balloon to build AMI models. Animals were imaged by SPECT GMPI before AMI and at 1 day, 1 week and 4 weeks after AMI, and quantitative analysis was performed to determine the extent of left ventricle (LV) perfusion defects, left ventricular systolic dyssynchrony (LVSD) and the LVDD parameters: phase histogram bandwidth (PBW) and phase standard deviation (PSD). Echocardiography was simultaneously applied to evaluate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the LVDD parameters: Te-12-diff and Te-12-SD. Myocardial injury markers were measured, and 12-lead ECGs were performed. The degree of LVR progression was defined as ΔLVESV (%) = (LVESVAMI4weeks - LVESVAMI1day)/LVESVAMI1day. RESULTS Thirteen swine completed the study. LVDD parameters changed dynamically at different time points after AMI. LVDD occurred as early as 1 day after AMI, peaked at 1 week, and trended toward a partial recovery at 4 weeks. Phase analysis on SPECT GMPI showed a significant correlation with tissue Doppler imaging for the assessment of LVDD during the longitudinal evaluation (r = 0.569 to 0.787, both P <0.05). During the univariate and multivariate regression analyses, the LVDD parameters PBW and PSD as of 1 day after AMI were significantly associated with the progression of LVR, respectively (PBW, β = 0.004, 95% CI 0.001 to 0.007, P = 0.024; PSD, β = 0.008, 95% CI 0.000 to 0.017, P = 0.049). Adjusted smooth curve fitting and threshold effect analysis indicated PBW and PSD break-point values of 142° and 60.4°, respectively, to predict the progression of LVR after AMI. CONCLUSIONS Phase analysis of SPECT GMPI can accurately and reliably characterize LVDD. LVDD occurred on the first day after AMI, reached its peak at 1 week, and partially recovered at 4 weeks after AMI. LVDD as evaluated by phase analysis of SPECT GMPI early after AMI was significantly associated with the progression of LVR. The early assessment of LVDD after AMI may provide helpful information for predicting the progression of LVR in the future.
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Affiliation(s)
- Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Min Xu
- Department of Echocardiogram, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Shengdeng Fan
- Department of Anesthesiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Xiaoxia Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Mei Xu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Minfu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoying Xi
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China.
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Fudim M, Dalgaard F, Fathallah M, Iskandrian AE, Borges-Neto S. Mechanical dyssynchrony: How do we measure it, what it means, and what we can do about it. J Nucl Cardiol 2021; 28:2174-2184. [PMID: 31144228 DOI: 10.1007/s12350-019-01758-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 01/14/2023]
Abstract
Left ventricular mechanical dyssynchrony (LVMD) is defined by a difference in the timing of mechanical contraction or relaxation between different segments of the left ventricle (LV). Mechanical dyssynchrony is distinct from electrical dyssynchrony as measured by QRS duration and has been of increasing interest due to its association with worse prognosis and potential role in patient selection for cardiac resynchronization therapy (CRT). Although echocardiography is the most used modality to assess LVMD, some limitations apply to this modality. Compared to echo-based modalities, nuclear imaging by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) has clear advantages in evaluating systolic and diastolic LVMD. GSPECT MPI can determine systolic and diastolic mechanical dyssynchrony by the variability in the timing in which different LV segments contract or relax, which has prognostic impact in patients with coronary artery disease and heart failure. As such, by targeting mechanical dyssynchrony instead of electrical dyssynchrony, GSPECT MPI can potentially improve patient selection for CRT. So far, few studies have investigated the role of diastolic dyssynchrony, but recent evidence seems to suggest high prevalence and more prognostic impact than previously recognized. In the present review, we provide an oversight of mechanical dyssynchrony.
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Affiliation(s)
- Marat Fudim
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Frederik Dalgaard
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Cardiology, Herlev & Gentofte Hospital, Copenhagen, Denmark
| | | | - Ami E Iskandrian
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salvator Borges-Neto
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
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Fudim M, Fathallah M, Shaw LK, James O, Samad Z, Piccini JP, Hess PL, Borges-Neto S. The prognostic value of diastolic and systolic mechanical left ventricular dyssynchrony among patients with coronary artery disease and heart failure. J Nucl Cardiol 2020; 27:1622-1632. [PMID: 31392509 DOI: 10.1007/s12350-019-01843-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prevalence and prognostic value of diastolic and systolic dyssynchrony in patients with coronary artery disease (CAD) + heart failure (HF) or CAD alone are not well understood. METHODS We included patients with gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) between 2003 and 2009. Patients had at least one major epicardial obstruction ≥ 50%. We assessed the association between dyssynchrony and outcomes, including all-cause and cardiovascular death. RESULTS Of the 1294 patients, HF was present in 25%. Median follow-up was 6.7 years (IQR 4.9-9.3) years with 537 recorded deaths. Patients with CAD + HF had a higher incidence of dyssynchrony than patients with CAD alone (diastolic BW 28.8% for the HF + CAD vs 14.7% for the CAD alone). Patients with CAD + HF had a lower survival than CAD alone at 10 years (33%; 95% CI 27-40 vs 59; 95% CI 55-62, P < 0.0001). With one exception, HF was found to have no statistically significant interaction with dyssynchrony measures in unadjusted and adjusted survival models. CONCLUSIONS Patients with CAD + HF have a high prevalence of mechanical dyssynchrony as measured by GSPECT MPI, and a higher mortality than CAD alone. However, clinical outcomes associated with mechanical dyssynchrony did not differ in patients with and without HF.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Mouhammad Fathallah
- Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Linda K Shaw
- Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Olga James
- Division of Nuclear Medicine, Duke Department of Radiology, Durham, NC, USA
| | - Zainab Samad
- Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Jonathan P Piccini
- Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Paul L Hess
- VA Eastern Colorado and Health Care System, Denver, CO, USA
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Truong V, Mazur W, Magier A, Broderick J, Safdar K, Volz B, Bartone C, Kereiakes DJ, Chung ES. Changes in mechanical dyssynchrony in severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Echocardiography 2019; 36:243-248. [PMID: 30623480 DOI: 10.1111/echo.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Aortic stenosis (AS) imposes a significant afterload on the left ventricle, but regional manifestations of the overall load may not be uniform, leading to mechanical dyssynchrony. Accordingly, we evaluated the prevalence of dyssynchrony in patients with severe AS at baseline as well as changes after transfemoral aortic valve replacement (TAVR). METHODS This study is a retrospective analysis of 225 patients in sinus rhythm who underwent TAVR for severe AS, in whom inter-ventricular and intra-ventricular dyssynchrony were measured at baseline, discharge, 1 month, and 1 year. Inter-ventricular dyssynchrony was defined as the difference between left and right ventricular pre-ejection intervals; intra-ventricular dyssynchrony was defined as the difference between time to peak systolic velocity of the basal septal and lateral segments. Patients were further stratified into those with QRS <120 ms or >120 ms. RESULTS At baseline, a quarter of patients met the criterion for significant inter-ventricular dyssynchrony, and a third had evidence of intra-ventricular dyssynchrony. Both decreased after TAVR although only the intra-ventricular dyssynchrony reached statistical significance. The interplay between QRS duration and changes in inter- and intra-ventricular dyssynchrony are also explored. CONCLUSIONS In patients with severe AS, there was evidence of mechanical dyssynchrony that is improved post-TAVR. Whether dyssynchrony is clinically and prognostically significant, and if it represents a potential target for additional therapy remains to be studied.
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Affiliation(s)
- Vien Truong
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Adam Magier
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - John Broderick
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Komal Safdar
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Brian Volz
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Cheryl Bartone
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Eugene S Chung
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
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