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Jalkh K, AlJaroudi W. Left ventricular mechanical dyssnchrony: A potential new marker for 3-vessel CAD. J Nucl Cardiol 2023; 30:1230-1234. [PMID: 36864242 DOI: 10.1007/s12350-023-03232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Khalil Jalkh
- Division of Cardiovascular Medicine, Augusta University-Medical College of Georgia, Office BB-6520B, Augusta, GA, USA
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, Augusta University-Medical College of Georgia, Office BB-6520B, Augusta, GA, USA.
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AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: single photon emission computed tomography. J Nucl Cardiol 2023; 30:452-478. [PMID: 36797458 DOI: 10.1007/s12350-023-03216-4] [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: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
In this review, we will summarize a selection of articles on single-photon emission computed tomography published in the Journal of Nuclear Cardiology in 2022. The aim of this review is to concisely recap major advancements in the field to provide the reader a glimpse of the research published in the journal over the last year. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including in prognosis, non-perfusion variables, attenuation compensation, machine learning and camera design. It will also review nuclear imaging advances in amyloidosis, left ventricular mechanical dyssynchrony, cardiac innervation, and lung perfusion. We encourage interested readers to go back to the original articles, and editorials, for a comprehensive read as necessary but hope that this yearly review will be helpful in reminding readers of articles they have seen and attracting their attentions to ones they have missed.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, GSB 446, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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AlJaroudi W. Left ventricular mechanical dyssynchrony in patient with CAD: The Saga continues. J Nucl Cardiol 2021; 28:3021-3024. [PMID: 32875523 DOI: 10.1007/s12350-020-02318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
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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.
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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
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Vij A, Malhotra S. Left ventricular regional asynchrony: Earliest marker for ischemic cardiomyopathy? J Nucl Cardiol 2021; 28:1051-1054. [PMID: 32901419 DOI: 10.1007/s12350-020-02355-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush Medical College, Chicago, IL, USA.
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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.
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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
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Hung GU, Zhou W, Chen J. A perfect tool for comprehensive evaluation of myocardial perfusion and function: Stress PET imaging. J Nucl Cardiol 2020; 27:2243-2246. [PMID: 30603888 DOI: 10.1007/s12350-018-01580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, No. 6, Lukong Road, Lukang Town, Changhua, 505, Taiwan.
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Mahfouz RA, Seaoud EA, Elbelbesy RA, Shehata IE. Resting Left Ventricular Dyssynchrony and Mechanical Reserve in Asymptomatic Normotensive Subjects with Early Type 2 Diabetes Mellitus. Pulse (Basel) 2020; 8:47-56. [PMID: 32999878 DOI: 10.1159/000506712] [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: 12/08/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Most diabetic patients have silent ischemia and cardiac dysfunction that is usually observed in the late phase of the disease when it becomes clinically obvious. We hypothesized that left ventricular dyssynchrony (LVdys) (or dispersion) is an early marker of myocardial involvement in asymptomatic early type 2 diabetes mellitus (T2DM) patients. Therefore, we aimed to detect early markers of myocardial dysfunction in early T2DM using LVdys and left ventricular mechanical reserve (LVMR). Methods We examined 91 consecutive subjects with early T2DM with speckle tracking imaging to evaluate LVdys and with dobutamine stress to evaluate LVMR (defined as left ventricular mechanical reserve global longitudinal strain [LVMRGLS] ≥2%). Our patients were divided into two groups according to LVdys: group 1 with LVdys (n = 49), and group 2 without LVdys (n = 42). Results We found that 49 (54%) subjects in our cohort had resting LVdys (standard deviation of tissue synchronization of the 12 left ventricular segments [Ts-SD-12] ≥34.2 ms). GLS and strain rate were comparable at rest between patients with and without LVdys. On the other hand, LVMR was blunted in those with LVdys (p < 0.001). We found that HbA1c, high-sensitivity C-reactive protein, and left atrial volume index were inversely correlated with LVMR. Multivariate analysis showed that LVdys was the strongest predictor (p < 0.001) of blunted LVMR. Using receiver operating characteristic curve analysis, we found that a Ts-SD-12 ≥36.5 ms was the best cutoff value to predict blunted LVMR (area under the curve = 0.89, p < 0.001). Conclusion The LVdys (Ts-SD-12) cutoff ≥36.5 ms was the optimal value for prediction of impaired LVMR and might be an early marker of subclinical cardiac dysfunction and risk stratification of subjects with asymptomatic early T2DM with preserved left ventricular ejection fraction.
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Affiliation(s)
- Ragab A Mahfouz
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Elshaimaa A Seaoud
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa A Elbelbesy
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Islam E Shehata
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Malhotra S. Dyssynchrony as a marker of adverse prognosis among patients with coronary artery disease and heart failure. J Nucl Cardiol 2020; 27:1633-1636. [PMID: 31722082 DOI: 10.1007/s12350-019-01945-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Saurabh Malhotra
- Cook County Health, Chicago, IL, USA.
- Rush Medical College, Chicago, IL, 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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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.
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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
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Malik D, Mittal B, Sood A, Parmar M, Kaur G, Bahl A. Left ventricular mechanical dyssynchrony assessment in long-standing type II diabetes mellitus patients with normal gated SPECT-MPI. J Nucl Cardiol 2019; 26:1650-1658. [PMID: 29392627 DOI: 10.1007/s12350-018-1208-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessment of left ventricular mechanical dyssynchrony (LVMD) using phase analysis of gated SPECT-MPI is well established. However, there is little information about the influence of diabetes mellitus on phase analysis. The present work was to evaluate the LVMD in longstanding type II diabetes mellitus (DM) patients with normal gated SPECT-MPI. METHODS Retrospective analysis of 146 (86 type II diabetics for > 5 years' duration and 60 nondiabetics) consecutive patients with normal gated SPECT-MPI and adequate LVEF was done. Sixty age- and sex-matched nondiabetic served as control. LVMD was determined from the cutoff values (> mean + 2 SD) observed for phase standard deviation (PSD) and phase bandwidth (PBW) from the control subjects. Multivariate logistic regression analysis was applied to assess the correlation between various confounding factors. RESULTS LVMD was detected in 24 (28%) diabetic patients with the pre-defined cut-off values for PSD (> 10.8) and PBW (> 35.6) derived from the controls. Hyperlipidemia, overweight/obesity, duration of DM and its long-term complications were independently associated with LVMD, with long-term complications being the highest risk factor (OR 28.00; P < .001). CONCLUSION The evolution time of the patients with type II diabetes mellitus affects the left ventricular mechanical synchrony.
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Affiliation(s)
- Dharmender Malik
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Madan Parmar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurvinder Kaur
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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The Prognostic Value of Diastolic and Systolic Mechanical Left Ventricular Dyssynchrony Among Patients With Coronary Heart Disease. JACC Cardiovasc Imaging 2019; 12:1215-1226. [DOI: 10.1016/j.jcmg.2018.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
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Gimelli A, Liga R, Menichetti F, Soldati E, Bongiorni MG, Marzullo P. Interactions between myocardial sympathetic denervation and left ventricular mechanical dyssynchrony: A CZT analysis. J Nucl Cardiol 2019; 26:509-518. [PMID: 28808889 DOI: 10.1007/s12350-017-1036-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony. METHODS Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) imaging. The summed rest score and summed 123I-MIBG score (SS-MIBG) were computed. The extent of "innervation/perfusion" mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified. RESULTS LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of "innervation/perfusion" mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of "innervation/perfusion" mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of "innervation/perfusion" mismatch was the only predictor of delayed mechanical activation (P = 0.029). CONCLUSIONS Patients with LVD show an elevated burden of "innervation/perfusion" mismatch that is concentrated at the level of the most dyssynchronous walls.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | | | - Francesca Menichetti
- Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy
| | | | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Doi T, Nakata T, Yuda S, Hashimoto A. Synergistic prognostic implications of left ventricular mechanical dyssynchrony and impaired cardiac sympathetic nerve activity in heart failure patients with reduced left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2018; 19:74-83. [PMID: 28158459 DOI: 10.1093/ehjci/jew334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/26/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Impairment of cardiac sympathetic innervation is a potent prognostic marker in heart failure, while left ventricular mechanical dyssynchrony (LVMD) has recently been noted as a novel prognosis determinant in heart failure patients with reduced LV ejection fraction (HFrEF). This study was designed to determine the correlation between cardiac sympathetic innervation quantified by metaiodobenzylguanidine (MIBG) activity and LVMD measured by electrocardiogram-gated myocardial perfusion imaging and to evaluate their incremental prognostic values in HFrEF patients. Methods and results A total of 570 consecutive HFrEF patients were followed up for 19.6 months with a primary endpoint of lethal cardiac events (CE) such as sudden cardiac death, death due to pump failure and appropriate ICD shock against life-threatening ventricular tachyarrhythmias. Cardiac sympathetic function and innervation were quantified as heart-to-mediastinum ratio (HMR) and washout kinetics of cardiac MIBG activity. LVMD was assessed by a standard deviation (SD) of systolic phase angle in gated myocardial perfusion imaging. Patients with CE (n = 166, 29%) had a significantly lower HMR and a significantly greater phase SD than did non-CE patients: 1.46 ± 0.28 vs. 1.63 ± 0.29, P < 0.0001 and 39.1 ± 11.6 vs. 33.1 ± 10.1, P < 0.0001, respectively. Compared to the single use of optimal cut-offs of late HMR (1.54) and phase SD (38), their combination more precisely discriminated high-risk or low-risk patients from others with log rank values from 7.78 to 65.2 (P = 0.0053 to P ≤ 0.0001). Among significant univariate variables, multivariate Cox proportional hazards model identified NYHA functional class, estimated glomerular filtration rate (eGFR), HMR 1.54 and phase SD 60 as significant determinants of CE with hazard ratios of 3.108 (95% CI, 2.472-3.910; P < 0.0001), 0.988 (95% CI, 0.981-0.996; P = 0.0021), 0.257 (95% CI, 0.128-0.498; P < 0.0001) and 1.019 (95% CI, 1.019-1.037; P = 0.0228), respectively. By combining the four independent determinants, the prognostic powers synergistically (P < 0.0001) increased maximally to 263.8. Conclusions Left ventricular mechanical dyssynchrony and impairment of cardiac sympathetic innervation are synergistically related to lethal cardiac events, contributing to better stratification of lethal cardiac event-risks and probably to optimization of therapeutic strategy in patients with HFrEF.
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Affiliation(s)
- Takahiro Doi
- Department of Cardiology, Obihiro-Kosei General Hospital, W6-S8-1, Obihiro, Hokkaido, 81-080-0016, Japan
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate Goryokaku Hospital, Goryokaku cho 38-3, Hakodate, Hokkaido, 81-040-8611, Japan
| | - Satoshi Yuda
- Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Chuo-ku S1-W16-291, Sapporo, Hokkaido, 81-060-8543, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Chuo-ku S1-W16-291, Sapporo, Hokkaido, 81-060-8543, Japan
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AlJaroudi W. Mechanical dyssynchrony with phase analysis of gated SPECT: Nap time is over. J Nucl Cardiol 2018; 25:2039-2043. [PMID: 28589379 DOI: 10.1007/s12350-017-0951-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
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17
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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.
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18
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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.
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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
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19
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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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20
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Malhotra S, Jain D. Detection of interventricular dyssynchrony: An evolution of the phase analysis technique. J Nucl Cardiol 2017; 24:1687-1689. [PMID: 27282162 DOI: 10.1007/s12350-016-0550-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: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Clinical and Translation Research Center, Suite 7030, Buffalo, NY, 14221, USA.
| | - Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College, Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY, USA
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21
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Chiang KF, Hung GU, Tsai SC, Cheng CM, Chang YC, Lin WY, Hsieh YC, Wu TJ, Chen SA, Huang JL, Liao YC, Chen J. Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia. J Nucl Cardiol 2017; 24:1282-1288. [PMID: 26979308 DOI: 10.1007/s12350-016-0447-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF). METHODS AND RESULTS Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF. CONCLUSIONS The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.
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Affiliation(s)
- Kuo-Feng Chiang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Shih-Chung Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Department of Health of Executive Yuan, Fong Yuan Hospital, Taichung, Taiwan
| | - Yu-Cheng Chang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Wan-Yu Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Divisions of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ying-Chieh Liao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiology, Department of Medicine, Buddhist Tzu-Chi General Hospital, Taichung Branch, 6688, Fung Hing Rd Sect 1, Tanzi District, Taichung, 427, Taiwan.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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22
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Zafrir N. Left ventricular mechanical dyssynchrony in patients with coronary artery disease. J Nucl Cardiol 2017; 24:491-493. [PMID: 26843202 DOI: 10.1007/s12350-016-0416-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Nili Zafrir
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
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23
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Hess PL, Shaw LK, Fudim M, Iskandrian AE, Borges-Neto S. The prognostic value of mechanical left ventricular dyssynchrony defined by phase analysis from gated single-photon emission computed tomography myocardial perfusion imaging among patients with coronary heart disease. J Nucl Cardiol 2017; 24:482-490. [PMID: 26809439 DOI: 10.1007/s12350-015-0388-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prognostic value of left ventricular dyssynchrony measured by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) and its relationship to electrical dyssynchrony measured by QRS duration are incompletely understood. The aim of this study was therefore to examine the independent and incremental prognostic value of dyssynchrony in yet the largest group of patients with coronary artery disease (CAD). METHODS AND RESULTS Patients presenting for GSPECT- MPI between July 1993 and May 1999 in normal sinus rhythm were identified from the Duke Nuclear Cardiology Databank and the Duke Databank for Cardiovascular Disease (N = 1244). After a median of 4.2 years, 336 deaths occurred. At 8 years, the Kaplan-Meier estimates of the probability of death were 34.0% among patients with a phase bandwidth <100° and 56.8% among those with a bandwidth ≥100°. After adjustment for standard clinical variables, QRS dyssynchrony was independently associated with death (Hazard Ratio (HR), per 10°: 1.092, 95% Confidence Interval (CI) 1.048,1.139, P < .0001). Phase bandwidth was similarly associated with death after clinical adjustment (HR per 10°: 1.056, 95% CI 1.041,1.072, P < .0001). In clinically adjusted models examining QRS duration in addition to phase bandwidth, phase bandwidth had a stronger association with mortality. After accounting for left ventricular ejection fraction (LVEF), neither QRS duration nor phase bandwidth were statistically significant. Among patients with EF >35%, QRS duration and phase bandwidth together provided value above that provided by LVEF alone (P = 0.0181). When examining cardiovascular death, results were consistent with all-cause death. CONCLUSIONS Among patients with CAD, mechanical left ventricular dyssynchrony measured by GSPECT MPI has a stronger relationship with outcomes than electrical dyssynchrony measured by QRS duration. After adjustment for baseline characteristics and LVEF, neither mechanical nor electrical dyssynchrony is independently associated with all-cause death or cardiac death. Among patients with EF >35%, mechanical and electrical dyssynchrony together provided prognostic value above that afforded by LVEF.
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Affiliation(s)
- Paul L Hess
- VA Eastern Colorado and Health Care System, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda K Shaw
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marat Fudim
- Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salvador Borges-Neto
- Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA.
- Division of Nuclear Medicine, Duke Department of Radiology, Durham, NC, USA.
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24
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Zafrir N, Bental T, Strasberg B, Solodky A, Mats I, Gutstein A, Kornowski R. Yield of left ventricular dyssynchrony by gated SPECT MPI in patients with heart failure prior to implantable cardioverter-defibrillator or cardiac resynchronization therapy with a defibrillator: Characteristics and prediction of cardiac outcome. J Nucl Cardiol 2017; 24:122-129. [PMID: 26563336 DOI: 10.1007/s12350-015-0310-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Mechanical left ventricular dyssynchrony (MLVD) might contribute in the therapeutic decision-making in patients with heart failure (HF) prior to cardiac resynchronization therapy (CRT). Our aim was to assess MLVD in patients with HF prior to implantable cardioverter-defibrillator (ICD) compared to patients with CRT-D. METHODS In a prospective study, patients with LVEF ≤ 35% who were scheduled for ICD or CRT-D, underwent gated SPECT myocardial perfusion imaging with technetium 99m sestamibi within 3 months prior procedure. MLVD was measured by phase analysis. RESULTS The study cohort consisted of 143 patients, 71 with ICD and 72 with CRT-D. Age 68.3 ± 11 and LVEF 24 ± 6%. Phase standard deviation (SD) was 62.5 ± 18 and 59.7 ± 20 (P = NS), respectively. During follow-up of 23.7 ± 12.1 months, there were 10 vs 14 cardiac death in ICD and CRT-D, respectively (P = NS), hospitalization for HF, in 34 vs 53 (P < .001). In multivariate analysis, Phase SD was the independent predictor for cardiac death [HR 2.66 (95% CI 1.046-6.768), P = .04]. Kaplan-Meier curves of phase SD of 60° significantly identified ICD patients with and without cardiac deaths and hospitalization for HF exacerbation. CONCLUSIONS MLVD by phase SD can identify patients with cardiac events and predict cardiac death in patients treated with ICD.
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Affiliation(s)
- Nili Zafrir
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
| | - Tamir Bental
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Boris Strasberg
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Alejandro Solodky
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Israel Mats
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ariel Gutstein
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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25
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Yoshinaga K. Predicting cardiac events using ventricular dyssynchrony in patients who received implantable cardioverter defibrillators: Are more treatment options required? J Nucl Cardiol 2017; 24:130-133. [PMID: 26601672 DOI: 10.1007/s12350-015-0326-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Keiichiro Yoshinaga
- Molecular Imaging Research Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan.
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26
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Malhotra S, Canty JM. Vasodilator stress and left ventricular asynchrony. J Nucl Cardiol 2017; 24:53-56. [PMID: 26494647 PMCID: PMC6310141 DOI: 10.1007/s12350-015-0292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Saurabh Malhotra
- Departments of Medicine, Biomedical Engineering and Physiology & Biophysics, The VA WNY Health Care System and the Clinical and Translational Research Center at the University at Buffalo, Buffalo, USA
- Division of Cardiovascular Medicine, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA
| | - John M Canty
- Departments of Medicine, Biomedical Engineering and Physiology & Biophysics, The VA WNY Health Care System and the Clinical and Translational Research Center at the University at Buffalo, Buffalo, USA.
- Division of Cardiovascular Medicine, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
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27
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Patel CD, Mukherjee A. Assessment of left ventricular mechanical dyssynchrony in coronary artery disease. J Nucl Cardiol 2016; 23:737-40. [PMID: 26358084 DOI: 10.1007/s12350-015-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Chetan D Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, B-54, South Extension Part-1, New Delhi, 110049, India.
| | - Anirban Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, B-54, South Extension Part-1, New Delhi, 110049, India
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28
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Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J Nucl Cardiol 2016; 23:728-36. [PMID: 26338425 DOI: 10.1007/s12350-015-0247-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/19/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera. METHODS Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth. RESULTS 415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction. CONCLUSIONS LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | | | - Brunella Favilli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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29
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Bajaj NS, Singh S, Farag A, El-Hajj S, Heo J, Iskandrian AE, Hage FG. The prognostic value of non-perfusion variables obtained during vasodilator stress myocardial perfusion imaging. J Nucl Cardiol 2016; 23:390-413. [PMID: 26940574 DOI: 10.1007/s12350-016-0441-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/21/2016] [Indexed: 11/25/2022]
Abstract
Myocardial perfusion imaging (MPI) is an established diagnostic test that provides useful prognostic data in patients with known or suspected coronary artery disease. In more than half of the patients referred for stress testing, vasodilator stress is used in lieu of exercise. Unlike exercise, vasodilator stress does not provide information on exercise and functional capacity, heart rate recovery, and chronotropy, and ECG changes are less frequent. These non-perfusion data provide important prognostic and patient management information. Further, event rates in patients undergoing vasodilator MPI are higher than in those undergoing exercise MPI and even in those with normal images probably due to higher pretest risk. However, there are a number of non-perfusion variables that are obtained during vasodilator stress testing, which have prognostic relevance but their use has not been well emphasized. The purpose of this review is to summarize the prognostic values of these non-perfusion data obtained during vasodilator MPI.
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Affiliation(s)
- Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Siddharth Singh
- Division of Cardiovascular Disease, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ayman Farag
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Stephanie El-Hajj
- Division of Cardiovascular Disease, Medical University of South Carolina, Charleston, SC, USA
| | - Jack Heo
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA.
- Section of Cardiology, Birmingham Veteran's Administration Medical Center, Birmingham, AL, USA.
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30
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Tsai SC, Chang YC, Chiang KF, Lin WY, Huang JL, Hung GU, Kao CH, Chen J. LV Dyssynchrony Is Helpful in Predicting Ventricular Arrhythmia in Ischemic Cardiomyopathy After Cardiac Resynchronization Therapy: A Preliminary Study. Medicine (Baltimore) 2016; 95:e2840. [PMID: 26886645 PMCID: PMC4998645 DOI: 10.1097/md.0000000000002840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
For patients with coronary artery disease, larger scar burdens are associated with higher risk of ventricular arrhythmia. Left ventricular (LV) dyssynchrony is associated with increased risk of sudden cardiac death in patients with heart failure. The purpose of this study was to assess the values of LV dyssynchrony and myocardial scar assessed by myocardial perfusion SPECT (MPS) in predicting the development of ventricular arrhythmia in ischemic cardiomyopathy. Twenty-two patients (16 males, mean age: 66 ± 13) with irreversible ischemic cardiomyopathy received cardiac resynchronization therapy (CRT) for at least 12 months were enrolled for MPS. Quantitative parameters, including LV dyssynchrony with phase standard deviation (phase SD) and bandwidth, left ventricular ejection fraction (LVEF), and scar (% of total areas), were generated by Emory Cardiac Toolbox. Ventricular tachycardia (VT) and ventricular fibrillation (VF) recorded in the CRT device during follow-up were used as the reference standard of diagnosing ventricular arrhythmia. Stepwise logistic regression analysis was performed for determining the independent predictors of VT/VF and receiver operating characteristic (ROC) curve analysis was used for generating the optimal cut-off values for predicting VT/VF. Nine (41%) of the 22 patients developed VT/VF during the follow-up periods. Patients with VT/VF had significantly lower LVEF, larger scar, larger phase SD, and larger bandwidth (all P < 0.05). Logistic regression analysis showed LVEF and bandwidth were independent predictors of VT/VF. ROC curve analysis showed the areas under the curves were 0.71 and 0.83 for LVEF and bandwidth, respectively. The optimal cut-off values were <36% and > 139° for LVEF and bandwidth, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 39%, 53%, and 100%, respectively, for LVEF; and were 78%, 92%, 88%, and 86%, respectively, for bandwidth. LV dyssynchrony as assessed by phase analysis of MPS is helpful for predicting ventricular arrhythmia in ischemic cardiomyopathy after CRT. Further implantation of defibrillator may be considered for those patients with bandwidth >139°.
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Affiliation(s)
- Shih-Chuan Tsai
- From the Department of Nuclear Medicine (S-CT, W-YL) and Cadiovascular Center (Y-CC, K-FC, J-LH), Taichung Veterans General Hospital; Department of Medical Imaging and Radiological Sciences (S-CT, G-UH), Central Taiwan University of Science and Technology; Department of Nuclear Medicine (G-UH), Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Medical Imaging and Radiological Sciences, China Medical University, Taichung, Taiwan (G-UH, C-HK); Department of Medicine, School of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan (J-LH); and Department of Radiology and Imaging Sciences (JC), Emory University School of Medicine, Atlanta, GA
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31
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Mukherjee A, Singh H, Patel C, Sharma G, Roy A, Naik N. Normal values of cardiac mechanical synchrony parameters using gated myocardial perfusion single-photon emission computed tomography: Impact of population and study protocol. Indian J Nucl Med 2016; 31:255-259. [PMID: 27833309 PMCID: PMC5041412 DOI: 10.4103/0972-3919.190803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose of the Study: Normal values of cardiac mechanical synchrony parameters in gated myocardial perfusion single-photon emission computed tomography (GMPS) are well established in literature from the Western population. The aim of the study is to establish normal values of mechanical synchrony with GMPS in Indian population and to find out whether it differs significantly from established values. Procedure: We retrospectively analyzed 1 day low-dose stress/high-dose rest GMPS studies of 120 patients (sixty males, 52 ± 11.7 years) with low pretest likelihood of coronary artery disease and having normal GMPS study. In GMPS, first-harmonic fast Fourier transform was used to extract a phase array using commercially available software. Phase standard deviation (PSD) and phase histogram bandwidth (PHB) were used to quantify cardiac mechanical dyssynchrony. Results: The values obtained were as follows, PSD: In men, 14.3 ± 4.7 (stress) and 8.9 ± 2.9 (rest), in women 11 ± 4 (stress) and 7.7 ± 2.7 (rest), and PHB: In men, 40.1 ± 11.9 (stress) and 30.6 ± 7.6 (rest), in women, 34.7 ± 12.6 (stress) and 25.3 ± 8.6 (rest). The value of PSD and PHB was significantly less in Indian population as compared with established values in literature. We also observed that synchrony indices derived from the low-dose stress studies are higher than high-dose rest studies. Conclusions: The value of synchrony parameters differs significantly according to population and methodology suggesting that specific population and methodology-based normal database for assessment of cardiac mechanical dyssynchrony should be established.
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Affiliation(s)
- Anirban Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Romero-Farina G, Aguadé-Bruix S, Candell-Riera J, Pizzi MN, García-Dorado D. Cut-off values of myocardial perfusion gated-SPECT phase analysis parameters of normal subjects, and conduction and mechanical cardiac diseases. J Nucl Cardiol 2015; 22:1247-58. [PMID: 26017712 DOI: 10.1007/s12350-015-0143-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine the cut-off values of gated myocardial perfusion rest SPECT phase analysis parameters of normal subjects, and conduction (CCD) and mechanical cardiac diseases (MCD). METHODS We prospectively analyzed 455 patients by means of phase analysis using SyncTool™ (Emory Cardiac Toolbox™). Of these, 150 corresponded to the control group (group 1, normal subjects) and 305 corresponded to patients with cardiac diseases (group 2, 63 with only CCD, 121 with only MCD, and 121 with CCD plus MCD). The optimal cut-off (CO) values of the peak phase (P), standard deviation (SD), bandwidth (B), skewness (S), and kurtosis (K) for discriminating between normal and dyssynchrony were obtained. RESULTS In order to differentiate group 1 from group 2, CO of SD > 18.4 and CO of B > 51 were the most sensitive parameters (75.7%, 95% CI 70.5%-80.4%, and 78.7%, 95% CI 73.7%-83.1%, respectively), and CO of S ≤ 3.2 and CO of K ≤ 9.3 were the most specific (92%, 95% CI 86.4%-95.8%, and 94.7%, 95% CI 89.8%-97.7%, respectively). In order to differentiate patients with CCD and MCD, CO values were SD > 26.1, B > 70, S ≤ 2.89, and K ≤ 10.2. In order to differentiate between patients with (n: 26) and without (n: 216) criteria of cardiac resynchronization therapy, CO values were SD > 40.2, B > 132, S ≤ 2.3, and K ≤ 4.6. CONCLUSIONS In this pilot study, different CO values of phase histogram parameters were observed between normal subjects and patients with conduction and MCD, and between patients with and without criteria of cardiac resynchronization therapy.
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Affiliation(s)
- Guillermo Romero-Farina
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- 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.
| | - 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
| | - 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
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Abstract
Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV) dyssynchrony, which also provides comprehensive assessment of LV function, global and regional scar burden, and patterns of LV mechanical activation. Preliminary studies indicate potential use in predicting cardiac resynchronization therapy response and elucidation of mechanisms. Because advances in technology may expand capabilities for precise LV lead placement in the future, identification of specific patterns of dyssynchrony may have a critical role in guiding cardiac resynchronization therapy.
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34
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Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving cardiac resynchronization therapy. Ann Nucl Med 2015; 29:772-8. [DOI: 10.1007/s12149-015-1007-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 12/01/2022]
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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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Singh H, Patel CD, Sharma P, Naik N, Singh S, Narang R. Does perfusion pattern influence stress-induced changes in left ventricular mechanical dyssynchrony on thallium-201-gated SPECT myocardial perfusion imaging? J Nucl Cardiol 2015; 22:36-43. [PMID: 25145635 DOI: 10.1007/s12350-014-9979-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/31/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The relationship between perfusion pattern and stress-induced changes in left ventricular mechanical dyssynchrony (LVMD) on stress-rest thallium-201-gated SPECT myocardial perfusion imaging (Tl-201 SPECT MPI) is not clear. The aim of the study is to assess the relation of perfusion pattern with stress-induced changes in LVMD on Tl-201 MPI. METHODS Data of 194 patients who underwent exercise-rest Tl-201 MPI between January to December 2012 at our institute was retrospectively evaluated. Institute Ethical committee approval was obtained. Fifty patients who underwent Tl-201 MPI for suspected CAD and had normal LV perfusion and function on MPI were taken as normal group. Patients with perfusion abnormalities (n = 144) were divided into three groups: ischemia (n = 66), infarct (n = 32), and mixed group (n = 46; ischemia and infarct both). Summed stress score, summed rest score, summed difference score (SDS), and LV ejection fraction (EF) were evaluated. Two LVMD parameters, phase standard deviation (PSD) and phase histogram bandwidth (PHB), were assessed in post-stress and rest MPI images. ΔPSD (post-stress PSD - rest PSD) and ΔPHB (post-stress PHB - rest PHB) were calculated to measure stress-induced changes in LVMD. RESULTS In all the groups, mean post-stress LVMD parameters were lower as compared to LVMD parameters at rest. Post-stress PSD was significantly lower than rest PSD in all groups. Similar trend was noted with PHB values also, but it was statistically significant in the normal and ischemia group only. Post-stress worsening of at least one of the LVMD parameters was noted in 28 patients and all these patients had perfusion abnormalities. But on subgroup analysis, no difference was found in proportion of patients showing post-stress worsening of LVMD between ischemia (13.6%), infarct (25%), and mixed (23.6%) groups. No significant correlation was found between ΔPSD/ΔPHB and ΔLVEF/SDS in any group. CONCLUSION LV mechanical dyssynchrony parameters are smaller in post-exercise stress as compared to rest on Tl-201 MPI, regardless of perfusion pattern. Stress-induced worsening of LV dyssynchrony was observed only in patients with perfusion abnormalities, but this is not related to the type of perfusion abnormality.
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Affiliation(s)
- Harmandeep Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, B-54, South Extension Part-1, New Delhi 110049, India
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37
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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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38
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Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Disease, American University of Beirut Medical Center, Beirut, Lebanon,
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Aggarwal H, AlJaroudi WA, Mehta S, Mannon R, Heo J, Iskandrian AE, Hage FG. The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease. J Nucl Cardiol 2014; 21:739-46. [PMID: 24858622 DOI: 10.1007/s12350-014-9886-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prior studies show that left ventricular mechanical dyssynchrony (LVD), measured by gated SPECT myocardial perfusion imaging (MPI), identifies patients with end-stage renal disease (ESRD) at higher risk for all-cause mortality but these were in small number of patients. We sought to assess the interaction between LVD and LV perfusion pattern in risk-stratification of a large sample size of patients with ESRD. METHODS From the renal transplantation database maintained at the University of Alabama at Birmingham, we identified consecutive patients with ESRD who had gated SPECT MPI between 2003 and 2007. MPIs were reprocessed to derive LV ejection fraction (EF), perfusion defect size, and LVD [phase bandwidth (BW) and phase standard deviation (SD)]. The primary end-point was all-cause mortality, which was prospectively collected and verified against the social security death index database. RESULTS There were 828 patients aged 52.6 ± 0.36 years (45% were women and 60% had diabetes mellitus). The LVEF was 54.8 ± 0.4% and the perfusion pattern was abnormal in 334 patients (41%). During a follow-up period of 61 ± 0.9 months, 230 patients (28%) received renal transplants and 290 patients (35%) died. The phase BW (73.1 ± 2.6° vs 66.3 ± 1.8°, P = .02) and SD (25.2 ± 0.8° vs 23.4 ± 0.5°, P = .06) were greater in patients who died than those who survived indicating greater dyssynchrony. Patients with phase BW >56° or SD ≥21° (median values) had worse 5-year survival (64% vs 72%, and 66% vs 71%, log-rank P = .005 and P = .07, respectively). After adjusting for demographics, co-morbidities, LVEF, and perfusion pattern, phase BW was associated with worse outcome (hazard ratio 1.289 95% CI 1.010-1.644, P = .04). CONCLUSIONS LVD by phase analysis of gated SPECT MPI provides prognostic value in ESRD beyond myocardial perfusion and EF.
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Affiliation(s)
- Himanshu Aggarwal
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35294, USA,
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40
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Zafrir N, Nevzorov R, Bental T, Strasberg B, Gutstein A, Mats I, Kornowski R, Solodky A. Prognostic value of left ventricular dyssynchrony by myocardial perfusion-gated SPECT in patients with normal and abnormal left ventricular functions. J Nucl Cardiol 2014; 21:532-40. [PMID: 24623397 DOI: 10.1007/s12350-014-9852-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular (LV) dyssynchrony by phase analysis has been studied by myocardial perfusion imaging (MPI)-gated SPECT in patients with LV dysfunction in various clinical settings. We aimed to investigate the routine use of phase analysis with gated SPECT for predicting cardiac outcome. METHODS Patients referred to a tertiary medical center in 2010-2011 prospectively underwent a gated SPECT and phase analysis, and follow-up for cardiac events. The values of clinical variables, MPI, LV function, and LV dyssynchrony in predicting cardiac events were tested by univariate and multivariate analyses. RESULTS The study group included 787 patients (66.5 ± 11 years, 81% men) followed for a mean duration of 18.3 ± 6.2 months. There were 45 (6%) cardiac events defined as composite endpoint; cardiac death occurred in 26 patients, and the rest had new-onset or worsening heart failure and life-threatening arrhythmias. In multivariate analysis, it was shown that NYHA class, diabetes mellitus, and LVEF <50% were the independent predictors for composite endpoint. However, the independent predictors for cardiac mortality were NYHA class (for each increment in class) and phase standard deviation (SD) (for each 10° increment). CONCLUSION Gated SPECT with phase analysis for the assessment of LV dyssynchrony can successfully predict cardiac death together with NYHA class, in patients with LV dysfunction.
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Affiliation(s)
- Nili Zafrir
- Nuclear Cardiology Unit, Rabin Medical Center, Beilinson Campus, 49100, Petah Tikva, Israel,
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41
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Hage FG, Garcia EV. The independent prognostic value of left ventricular dyssynchrony. J Nucl Cardiol 2014; 21:541-3. [PMID: 24623398 DOI: 10.1007/s12350-014-9878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA,
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Petretta M, Petretta A, Pellegrino T, Nappi C, Cantoni V, Cuocolo A. Role of nuclear cardiology for guiding device therapy in patients with heart failure. World J Meta-Anal 2014; 2:1-16. [DOI: 10.13105/wjma.v2.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 02/05/2023] Open
Abstract
Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy (CRT) and to select patients for implantable cardioverter defibrillators (ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.
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Hage FG, Aggarwal H, Patel K, Chen J, Jacobson AF, Heo J, Ahmed A, Iskandrian AE. The relationship of left ventricular mechanical dyssynchrony and cardiac sympathetic denervation to potential sudden cardiac death events in systolic heart failure. J Nucl Cardiol 2014; 21:78-85. [PMID: 24170623 DOI: 10.1007/s12350-013-9807-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with heart failure (HF) are at increased risk for left ventricular (LV) dyssynchrony which is associated with sudden cardiac death (SCD). This study examined the association of LV mechanical dyssynchrony and cardiac sympathetic denervation with potential SCD events in symptomatic patients with HF and reduced ejection fraction (HFrEF). METHODS Of the 917 HFrEF patients in ADMIRE-HF, 92 experienced adjudicated potential SCD events during a 17 months median follow-up. Propensity scores were used to assemble a matched cohort of 85 pairs of patients with and without potential SCD events. ADMIRE-HF subjects had rest gated SPECT Tc-99m and I-123 MIBG imaging. Perfusion images were processed using phase analysis software to derive phase standard deviation (SD), an index of mechanical dyssynchrony. RESULTS Of the 92 patients who experienced adjudicated potential SCD events 23 had SCD, 5 fatal myocardial infarction, 7 resuscitated cardiac arrest, 46 had appropriate ICD therapy, and 11 had sustained ventricular tachycardia. Patients who experienced potential SCD events had significantly wider phase SD than matched control patients (62.3 ± 2.4º vs 55.5 ± 2.3º, P = .03) and were more likely to have a phase SD ≥ 60º (53 % vs 35 %, P = .03). Fewer patients with potential SCD events (6 % vs 15 % of the controls, P = .08) had an MIBG heart/mediastinum uptake-ratio ≥1.6. CONCLUSIONS Among symptomatic HFrEF patients, LV mechanical dyssynchrony is independently associated with potential SCD events. Phase analysis may provide incremental prognostic information on top of current indicators of SCD risk in HFrEF.
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Affiliation(s)
- Fadi G Hage
- University of Alabama at Birmingham, Zeigler Research Building 1024, 703 19th Street South, Birmingham, AL, 35294, USA,
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Goldberg AS, Alraies MC, Cerqueira MD, Jaber WA, Aljaroudi WA. Prognostic value of left ventricular mechanical dyssynchrony by phase analysis in patients with non-ischemic cardiomyopathy with ejection fraction 35-50% and QRS < 150 ms. J Nucl Cardiol 2014; 21:57-66. [PMID: 24092272 DOI: 10.1007/s12350-013-9787-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony (LVMD) by phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a useful tool for predicting response to cardiac resynchronization therapy and has prognostic value. While most of the studies were done on patients with ischemic cardiomyopathy or those with LV ejection fraction (EF) < 35%, there are little data on the prognostic value of LVMD in patients with non-ischemic cardiomyopathy (NICM), particularly those with mildly decreased systolic function and narrow or intermediate QRS duration. METHODS AND RESULTS From the stress SPECT-MPI database at Cleveland Clinic, we identified 324 consecutive patients (mean age 62 ± 13 years, 62% male, 36% diabetics) with NICM, LVEF 35-50% (median [Q1,Q3] 45 [41,49]), and QRS < 150 ms (13% with QRS 120-149 ms). LVMD was determined from gated stress images and expressed as phase standard deviation (SD) and histogram BW (% R-R cycle). For easier graphical illustration, patients were divided into tertiles of LVMD. All-cause death was the primary endpoint and determined using the Social Security Death Index. Cox proportional hazard model was performed to determine the independent predictive value of LVMD, and next Cox models for incremental value. After a mean follow-up time of 1,689 days, 86 (26.5%) of patients died. These patients were older, had more diabetes, more use of diuretics, with wider QRS duration, and with a trend for higher phase SD and BW. After adjusting for age, hypertension, diabetes, aspirin, beta-blockers, diuretics, QRS, and EF, phase SD was an independent predictor of all-cause mortality with hazard ratio [95% CI] 1.97 [1.06,3.66] for the highest tertile, and added incremental prognostic value (P = .025). Similar findings were obtained using histogram BW. CONCLUSION In patients with NICM, EF 35-50%, and QRS < 150 ms, increased LVMD on peak stress SPECT was an independent predictor of all-cause mortality. The utility and applicability of such findings in clinical practice need further evaluation in larger and prospective studies.
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Affiliation(s)
- Adam S Goldberg
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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45
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Hage FG. Left ventricular mechanical dyssynchrony by phase analysis as a prognostic indicator in heart failure. J Nucl Cardiol 2014; 21:67-70. [PMID: 24272972 DOI: 10.1007/s12350-013-9822-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA,
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46
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Prognostic significance of left ventricular dyssynchrony by phase analysis of gated SPECT in medically treated patients with dilated cardiomyopathy. Clin Nucl Med 2014; 38:510-5. [PMID: 23698460 DOI: 10.1097/rlu.0b013e318292eedf] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The study aimed to investigate the value of clinical variables and rest gated single-photon emission computed tomography (SPECT) in predicting cardiac deaths in medically treated dilated cardiomyopathy (DCM) patients. METHODS This is a retrospective study. Fifty-six consecutive hospitalized DCM patients who underwent rest gated SPECT myocardial perfusion imaging were initially recruited. Patients were further excluded for receiving heart transplantation, cardiac resynchronization treatment, and noncardiac death during follow-up. The remaining 48 medically treated DCM patients were selected into the final analysis. Phase analysis of gated SPECT was conducted to identify left ventricular (LV) dyssynchrony. Cardiac death during follow-up was considered as the only endpoint. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent predictors of cardiac death. Kaplan-Meier cumulative survival analysis with stratification was performed, and survival curves were compared by log-rank test. RESULTS The mean age was 47.5 ± 15.8 years (range, 15-76 yrs) and 85.4% were men. The mean LV ejection fraction was 22.2 ± 7.7%. During the follow-up period (22.7 ± 5.1 mos), 12 (25.0%) cardiac deaths occurred. Compared to survivors, patients with cardiac death had lower body mass index (BMI, P = 0.010), higher percent of prolonged QRS duration (QRSD, P = 0.043), and severe LV dyssynchrony (P = 0.002). Multivariate Cox analysis demonstrated that severe LV dyssynchrony [hazard ratio = 9.607, 95% confidential interval (95% CI) 2.064-44.713, P = 0.004] and BMI (hazard ratio = 0.851, 95% CI 0.732-0.989, P = 0.036) were predictive of cardiac death. CONCLUSION Left ventricular dyssynchrony assessed by phase analysis of gated SPECT and BMI are predictive of cardiac death in medically treated DCM patients.
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Aljaroudi WA, Flamm SD, Saliba W, Wilkoff BL, Kwon D. Role of CMR imaging in risk stratification for sudden cardiac death. JACC Cardiovasc Imaging 2013; 6:392-406. [PMID: 23473115 DOI: 10.1016/j.jcmg.2012.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 12/28/2022]
Abstract
Left ventricular ejection fraction as determined by echocardiography has a limited sensitivity in predicting risk for sudden cardiac death (SCD). Subsequent efforts to improve cost-effectiveness of device implantation and identify a better risk-stratifying tool have been quite desirable. The presence of scar and myocardial tissue heterogeneity has been linked to ventricular arrhythmia, which is believed to be the major cause of SCD. Cardiac magnetic resonance is a noninvasive imaging modality that visualizes and quantifies scar, with growing evidence delineating its additive value in identifying patients at higher risk for SCD.
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MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/pathology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Cardiomyopathies/complications
- Cardiomyopathies/diagnosis
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Humans
- Magnetic Resonance Imaging
- Myocardium/pathology
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
- Stroke Volume
- Ventricular Function, Left
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Affiliation(s)
- Wael A Aljaroudi
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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Left-ventricular dyssynchrony evaluated by Tl-201 gated SPECT myocardial perfusion imaging: a comparison with Tc-99m sestamibi. Nucl Med Commun 2013; 34:229-32. [PMID: 23238227 DOI: 10.1097/mnm.0b013e32835c91b9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has been validated as a reliable tool to assess left-ventricular (LV) mechanical dyssynchrony. The initial results were all confirmed from studies using technetium-99m (Tc-99m) sestamibi or tetrofosmin as the radiotracers. The purpose of this study was to evaluate the feasibility of phase analysis in thallium-201 (Tl-201) gated SPECT MPI. MATERIALS AND METHODS Seventeen patients referred from a cardiology clinic for evaluation of coronary artery disease were studied. All patients underwent both Tl-201 and Tc-99m sestamibi gated SPECT MPI within 1 week. An additional 34 patients with Tl-201 gated SPECT and 22 patients with Tc-99m sestamibi gated SPECT, who had a low likelihood of coronary artery disease, normal LV function, and normal perfusion on MPI, were used as normal controls. LV dyssynchrony parameters, including phase standard deviation (PSD) and phase histogram bandwidth (PHB), were measured using a standard phase analysis tool and compared between Tl-201 and Tc-99m sestamibi images. RESULTS The LV dyssynchrony parameters correlated well (r=0.93 for PSD and r=0.84 for PHB) between Tl-201 and Tc-99m sestamibi images. The dyssynchrony parameters of Tl-201 were significantly larger than those of Tc-99m sestamibi (PSD: 24.5±12.0 vs. 17.4±9.7, P<0.001; PHB: 74.7±35.5 vs. 50.6±25.0, P<0.001). In comparison with normal controls, Tl-201 and Tc-99m sestamibi images showed concordant results. CONCLUSION LV dyssynchrony parameters correlated well between Tl-201 and Tc-99m sestamibi images, even though the values were significantly larger for Tl-201 than for Tc-99m sestamibi. Tl-201 images showed results similar to those of Tc-99m sestamibi in the diagnosis of LV dyssynchrony.
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Wang NC, Piccini JP, Fonarow GC, Knight BP, Harinstein ME, Butler J, Lahiri MK, Metra M, Vaduganathan M, Gheorghiade M. The potential role of nonpharmacologic electrophysiology-based interventions in improving outcomes in patients hospitalized for heart failure. Heart Fail Clin 2013; 9:331-43, vi-vii. [PMID: 23809419 DOI: 10.1016/j.hfc.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospitalization for heart failure (HHF) is commonly associated with symptomatic improvement in response to standard medical therapy, yet there remains a substantial risk of rehospitalization and death. Clinically stable outpatients and decompensated inpatients represent two types of patients with chronic heart failure. In the former, treatment of common heart rhythm disorders with nonpharmacologic electrophysiology-based interventions is of substantial benefit in select patients. The potential benefits of these interventions in the hospitalized setting are not well studied. In this review, current knowledge is discussed and future research directions are suggested with nonpharmacologic electrophysiology-based interventions to reduce the morbidity and mortality associated with patients with HHF.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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