Left ventricular dyssynchrony and abnormalities in wall motion, assessed by gated-SPECT as ischemic auxiliary markers
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Left ventricular dyssynchrony (LVD) quantified by gated myocardial perfusion studies (MPS), through phase analysis (PA), has shown controversial results in myocardial stunning.
Assessment of LVD and regional wall motion abnormalities (RWMA) in normal and ischemic patients.
A cohort of 172 patients were studied. Summed Stress Score (SSS), Summed Resting Score (SRS), and Summed Difference Score (SDS) were evaluated. Group 1-patients with normal MPS (N = 133) and Group 2-patients with myocardial ischemia in the MPS (N = 39). LVD was evaluated through PA and RWM by visual analysis.
SSS 0 vs 9.8 ± 3.9 P = .0001; SDS 0 vs 9.8 ± 3.9 P = .0001; SRS 0 vs 0 P = NS, in G1 and G2. Significant differences were found in LVD between G1 and G2, bandwidth 36 ± 14 vs 63 ± 46 P = .0001; standard deviation 16 ± 10 vs 26 ± 15 P = .0001. In G1, 16% had LVD vs RWMA in 0%, P = .0001 and in G2, 59% with LVD vs 33% with RWMA, P = .03. Sensitivity for LVD 59% and for RWMA 33%, P = .03 and specificity for LVD 83% and for RWMA 100%, P = .0001.
Ischemic patients have LVD post-stress due to myocardial stunning. LVD measured by PA could be a useful tool to identify ischemia.
KeywordsMyocardial perfusion studies left ventricular dyssynchrony phase analysis standard deviation
Left ventricular dyssynchrony
Myocardial perfusion study
Regional wall motion abnormalities
Summed stress score
Summed resting score
Summed difference score
Coronary artery disease
There are no conflicts of interest between the authors.
- 1.Zoghbi GJ, Iskandrian AE. Nuclear cardiac imaging. Exercise myocardial perfusion imaging (chapter 15). 4th ed. Oxford: Oxford University Press; 2008.Google Scholar
- 2.Berman DS, Kang X, Slomka PJ, Gerlach J, de Yang L, Hayes SM, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol 2007;14:521-8.Google Scholar
- 3.Emmett L, Ng A, Ha L, Russo R, Mansberg R, Zhao W, et al. Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: Myocardial stunning or subendocardial hypoperfusion? J Nucl Cardiol 2012;19:735-42.Google Scholar
- 4.Camilletti J, Fabris N, Escudero E, Ronderos R, Corneli D, Mele A. Correlacion entre Gated SPECT y Eco 2D en la valoracion de la funcion ventricular izquierda. Rev Fed Arg Cardiol 2000;29:489-93.Google Scholar
- 5.Johnson LL, Verdesca SA, Aude WY, Xavier RC, Nott LT, Campanella NW, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on poststress gated sestamibi tomograms. J Am Coll Cardiol 1997;30:1641-8.Google Scholar
- 6.Daou D, Coaguila C, Delahaye N, Houzet F, Lebtahi R, Le Guludec D. Discordance between exercise SPECT lung Tl-201 uptake and left ventricular transient ischemic dilation in patients with CAD. J Nucl Cardiol 2004;11:53-61.Google Scholar
- 7.Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by Phase analysis of ECG-gated myocardial Perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-95.Google Scholar
- 8.Marsan NA, Henneman MM, Chen J, Ypenburg C, Dibbets P, Ghio S, et al. Real-time three-dimensional echocardiography as a novel approach to quantify left ventricular dyssynchrony: A comparison study with phase analysis of gated myocardial perfusion single photon emission computed tomography. J Am Soc Echocardiogr 2008;21:801-7.Google Scholar
- 9.AlJaroudi W, Alraies MC, Hachamovitch R, Jaber WA, Brunken R, Cerqueira MD, et al. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: A study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS. Eur J Nucl Med Mol Imaging 2012;39:1581-91.Google Scholar
- 10.AlJaroudi W, Aggarwal H, Venkataraman R, Heo J, Iskandrian AE, Hage FG. Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease. J Nucl Cardiol 2010;17:1058-64.Google Scholar
- 11.Henneman MM, Chen J, Ypenburg C, Dibbets P, Bleeker GB, Boersma E, et al. Phase analysis of gated myocardial Perfusion SPECT compared to tissue Doppler imaging for the assessment of left ventricular dyssynchrony. J Am Coll Cardiol 2007;49:1708-14.Google Scholar
- 12.Marsan NA, Henneman MM, Chen J, Ypenburg C, Dibbets P, Ghio S, et al. Left ventricular dyssynchrony assessed by two three-dimensional imaging modalities: Phase analysis of gated myocardial perfusion SPECT and tri-plane tissue Doppler imaging. Eur J Nucl Med Mol Imaging 2008;35:166-73.Google Scholar
- 13.Huang WS, Huang CH, Lee CL, Chen CP, Hung GU, Chen J. Relation of early post-stress left ventricular dyssynchrony and the extent of angiographic coronary artery disease. J Nucl Cardiol 2014;21:1048-56.Google Scholar
- 14.Nakanishi R, Gransar H, Slomka P, Doppalapudi H, Venkataraman R, Heo J, et al. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. J Nucl Cardiol 2016;23:530-41.Google Scholar
- 15.AlJaroudi W, Koneru J, Heo J, Iskandrian A. Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2011;18:36-42.Google Scholar