TY - JOUR
T1 - Evaluation of left ventricular mechanical dyssynchrony as determined by phase analysis of ECG-gated SPECT myocardial perfusion imaging in patients with left ventricular dysfunction and conduction disturbances
AU - Trimble, Mark A.
AU - Borges-Neto, Salvador
AU - Smallheiser, Stuart
AU - Chen, Ji
AU - Honeycutt, Emily F.
AU - Shaw, Linda K.
AU - Heo, Jaekyeong
AU - Pagnanelli, Robert A.
AU - Tauxe, E. Lindsey
AU - Garcia, Ernest V.
AU - Esteves, Fabio
AU - Seghatol-Eslami, Frank
AU - Kay, G. Neal
AU - Iskandrian, Ami E.
N1 - Funding Information:
This study was funded in part by a research grant from the Medtronic-Duke Strategic Alliance, of which Dr Borges-Neto is the primary investigator.
PY - 2007/5
Y1 - 2007/5
N2 - Background: Cardiac resynchronization therapy (CRT) is approved for the treatment of patients with advanced systolic heart failure and evidence of dyssynchrony on electrocardiograms. However, a significant percentage of patients do not demonstrate improvement with CRT. Echocardiographic techniques have been used for more accurate determination of dyssynchrony. Single photon emission computed tomography (SPECT) myocardial perfusion imaging has not previously been used to evaluate cardiac dyssynchrony. The objective of this study is to evaluate mechanical dyssynchrony as described by phase analysis of gated SPECT images in patients with left ventricular dysfunction, conduction delays, and ventricular paced rhythms. Methods and Results: A novel count-based method is used to extract regional systolic wall thickening amplitude and phase from gated SPECT images. Five indices describing the phase dispersion of the onset of mechanical contraction are determined: peak phase, phase SD, bandwidth, skewness, and kurtosis. These indices were determined in consecutive patients with left ventricular dysfunction (n = 120), left bundle branch block (n = 33), right bundle branch block (n = 19), and ventricular paced rhythms (n = 23) and were compared with normal control subjects (n = 157). Phase SD, bandwidth, skewness, and kurtosis were significantly different between patients with left ventricular dysfunction, left bundle branch block, right bundle branch block, and ventricular paced rhythms and normal control subjects (all P < .001) Peak phase was significantly different between patients with right ventricular paced rhythms and normal control subjects (P = .001). Conclusions: A novel SPECT technique for describing left ventricular mechanical dyssynchrony has been developed and may prove useful in the evaluation of patients for CRT.
AB - Background: Cardiac resynchronization therapy (CRT) is approved for the treatment of patients with advanced systolic heart failure and evidence of dyssynchrony on electrocardiograms. However, a significant percentage of patients do not demonstrate improvement with CRT. Echocardiographic techniques have been used for more accurate determination of dyssynchrony. Single photon emission computed tomography (SPECT) myocardial perfusion imaging has not previously been used to evaluate cardiac dyssynchrony. The objective of this study is to evaluate mechanical dyssynchrony as described by phase analysis of gated SPECT images in patients with left ventricular dysfunction, conduction delays, and ventricular paced rhythms. Methods and Results: A novel count-based method is used to extract regional systolic wall thickening amplitude and phase from gated SPECT images. Five indices describing the phase dispersion of the onset of mechanical contraction are determined: peak phase, phase SD, bandwidth, skewness, and kurtosis. These indices were determined in consecutive patients with left ventricular dysfunction (n = 120), left bundle branch block (n = 33), right bundle branch block (n = 19), and ventricular paced rhythms (n = 23) and were compared with normal control subjects (n = 157). Phase SD, bandwidth, skewness, and kurtosis were significantly different between patients with left ventricular dysfunction, left bundle branch block, right bundle branch block, and ventricular paced rhythms and normal control subjects (all P < .001) Peak phase was significantly different between patients with right ventricular paced rhythms and normal control subjects (P = .001). Conclusions: A novel SPECT technique for describing left ventricular mechanical dyssynchrony has been developed and may prove useful in the evaluation of patients for CRT.
KW - Myocardial perfusion imaging
KW - gated single photon emission computed tomography
KW - heart failure
UR - http://www.scopus.com/inward/record.url?scp=34249672086&partnerID=8YFLogxK
U2 - 10.1016/j.nuclcard.2007.01.041
DO - 10.1016/j.nuclcard.2007.01.041
M3 - Article
C2 - 17556163
AN - SCOPUS:34249672086
SN - 1071-3581
VL - 14
SP - 298
EP - 307
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
IS - 3
ER -