Original articleEvaluation of left ventricular mechanical dyssynchrony as determined by phase analysis of ECG-gated SPECT myocardial perfusion imaging in patients with left ventricular dysfunction and conduction disturbances
Section snippets
OMC Determination and Phase Analysis
Each subject enrolled in this study underwent a standard ECG-gated SPECT myocardial perfusion scan for clinical indications at 1 of 3 participating medical centers. Data were acquired at 8 frames per cardiac cycle. The R-R window used for gating was averaged from the prescan electrocardiogram. The short-axis data sets were generated by Butterworth filtering, followed by filtered backprojection reconstruction and oblique reorientation. Three-dimensional count distributions were then extracted
Results
Table 2 shows the 5 quantitative indices describing the left ventricular regional OMC in subjects with left ventricular dysfunction and normal control subjects. Peak phase did not differ significantly between subjects with left ventricular dysfunction and normal control subjects (130.8° ± 28.3° vs 134.8° ± 18.7°, P = .15). However, phase SD (47.8° ± 19.4° vs 15.7° ± 11.8°, P < .001), bandwidth (147.0° ± 70.9° vs 42.0° ± 28.4°, P < .001), skewness (2.7 ± 0.8 vs 4.6 ± 2.4, P < .001), and kurtosis
Discussion
CRT is approved for the treatment of patients with New York Heart Association class III/IV heart failure symptoms who have ejection fractions of 35% or less and a QRS duration of greater than 120 milliseconds on a surface electrocardiogram. Several studies have shown benefits with CRT when added to optimal medical therapy for groups of patients who meet these selection criteria. These benefits include improved functional status, exercise tolerance, quality of life, and left ventricular reverse
Acknowledgment
Dr. Garcia reports an ownership interest in and serves as a consultant/advisor board member to Syntermed Inc. Dr. Garcia also receives royalties from the sale of clinical software that was used as part of this research. Mr. Pagnanelli is a member of the speaker’s bureau for GE Healthcare.
References (53)
- et al.
Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias
J Am Coll Cardiol
(2003) - et al.
Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS
J Am Coll Cardiol
(2003) - et al.
Effects of dual chamber pacing with short atrioventricular delay in dilated cardiomyopathy
Lancet
(1992) - et al.
Cardiac resynchronization therapy: part 1—issues before device implantation
J Am Coll Cardiol
(2005) - et al.
An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis
Am J Cardiol
(1982) - et al.
Diagnosis of arrythmogenic right ventricular cardiomyopathy by Fourier analysis of gated blood pool single-photon emission tomography
Am J Cardiol
(1998) - et al.
Potential added value of three-dimensional reconstruction and display of single photon emission computed tomographic gated blood pool images
J Nucl Cardiol
(1998) - et al.
Onset of left ventricular contraction determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony
J Nucl Cardiol
(2005) - et al.
Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony
J Am Coll Cardiol
(2002) - et al.
Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy
J Am Coll Cardiol
(2005)
Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients undergoing cardiac resynchronization therapy
J Am Coll Cardiol
Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment
Am Heart J
Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch block
Am J Cardiol
Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing
J Am Coll Cardiol
Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation
Am J Cardiol
Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy
Am J Cardiol
Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy
J Am Coll Cardiol
Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy
Am J Cardiol
Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy
J Am Coll Cardiol
Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block
J Am Coll Cardiol
Evaluation of ventricular synchrony using novel Doppler echocardiographic indices in patients with heart failure receiving cardiac resynchronization therapy
J Am Soc Echocardiogr
Utility of echocardiographic radial strain imaging to quantify left ventricular dyssynchrony and predict acute response to cardiac resynchronization therapy
Am J Cardiol
Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy
Am J Cardiol
A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging
J Am Coll Cardiol
Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: a prognostic study with Fourier phase analysis of radionuclide angioscintigraphy
J Am Coll Cardiol
Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony
J Am Coll Cardiol
Cited by (89)
Effect of left ventricular mechanical dyssynchrony assessed pre-renal transplantation on cardiovascular death post transplantation
2022, Journal of Nuclear CardiologyAre SPECT MPI measures of dyssynchrony dyssynchronous?
2021, Journal of Nuclear CardiologyNovel indices representing heterogeneous distributions of myocardial perfusion imaging
2024, Annals of Nuclear Medicine
This study was funded in part by a research grant from the Medtronic-Duke Strategic Alliance, of which Dr Borges-Neto is the primary investigator.