Diastolic dyssynchrony assessment by gated myocardial perfusion-SPECT in subjects who underwent cardiac resynchronization therapy

  • Erick Alexanderson-RosasEmail author
  • Nilda Espinola-Zavaleta
  • Ernest V. Garcia
  • Amalia Peix
  • Teresa Massardo
  • Luz M. Pabon
  • Neftali Eduardo Antonio-Villa
  • Isabel Carvajal-Juarez
  • Claudio T. Mesquita
  • Amelia Jimenez-Heffernan
  • Chetan Patel
  • Ganesan Karthikeyan
  • Alka Kumar
  • Sadaf Butt
  • Mani Kalaivani
  • Victor Marin
  • Olga Morozova
  • Diana Paez
Original Article



Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period.

Material & Methods

Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°.


Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P < 0.001). LVDD was not associated with improvement in clinical outcomes at follow-up.


CRT improves both systolic and diastolic dyssynchrony values at 6-month follow-up. LVDD at baseline is correlated with cardiac functionality at follow-up, but not with overall favorable clinical outcomes.


Diastolic dyssynchrony SPECT resynchronization therapy nuclear medicine 



Minnesota living with heart failure questionnaire


Cardiac resynchronization therapy


Left ventricular systolic dyssynchrony


Left ventricular diastolic dyssynchrony


Left ventricular systolic phase standard deviation


Left ventricular diastolic phase standard deviation


End-systolic eccentricity index


End-diastolic eccentricity index


Gated myocardial perfusion single-photon emission computed tomography



Nothing to disclose.


This study presents the results of an International Atomic Energy Agency (IAEA) multicenter trial: ‘‘Value of intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients submitted to cardiac resynchronization therapy’’ (IAEA VISION-CRT), Coordinated Research Protocol E1.30.34, and received funds from IAEA.

Supplementary material

12350_2019_1845_MOESM1_ESM.docx (326 kb)
Electronic supplementary material 1 (DOCX 326 kb)
12350_2019_1845_MOESM2_ESM.docx (194 kb)
Electronic supplementary material 2 (DOCX 194 kb)
12350_2019_1845_MOESM3_ESM.docx (190 kb)
Electronic supplementary material 3 (DOCX 190 kb)
12350_2019_1845_MOESM4_ESM.docx (165 kb)
Electronic supplementary material 4 (DOCX 165 kb)
12350_2019_1845_MOESM5_ESM.pptx (10.4 mb)
Electronic supplementary material 5 (PPTX 10686 kb)
12350_2019_1845_MOESM6_ESM.mp3 (4.3 mb)
Electronic supplementary material 6 (MP3 4453 kb)


  1. 1.
    Bader H, Garrigue S, Lafitte S, Reuter S, Jais P, Haissaguerre M, et al. Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 2004;43:248-56.CrossRefGoogle Scholar
  2. 2.
    Cho GY, Song JK, Park WJ, Han SW, Choi SH, Doo YC, et al. Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration. J Am Coll Cardiol 2005;46:2237-43.CrossRefGoogle Scholar
  3. 3.
    Schuster I, Habib G, Jego C, Thuny F, Avierinos JF, Derumeaux G, et al. Diastolic asynchrony is more frequent than systolic asynchrony in dilated cardiomyopathy and is less improved by cardiac resynchronization therapy. J Am Coll Cardiol 2005;46:2250-7.CrossRefGoogle Scholar
  4. 4.
    Xiao HB, Lee CH, Gibson DG. Effect of left bundle branch block on diastolic function in dilated cardiomyopathy. Br Heart J 1991;66:443-7.CrossRefGoogle Scholar
  5. 5.
    Waggoner AD, Rovner A, de las Fuentes L, Faddis MN, Gleva MJ, Sawhney N, et al. Clinical outcomes after cardiac resynchronization therapy: Importance of left ventricular diastolic function and origin of heart failure. J Am Soc Echocardiogr 2006;19:307-13.CrossRefGoogle Scholar
  6. 6.
    Friedberg MK, Roche SL, Mohammed AF, Balasingam M, Atenafu EG, Kantor PF. Left ventricular diastolic mechanical dyssynchrony and associated clinical outcomes in children with dilated cardiomyopathy. Circ Cardiovasc Imaging 2008;1:50-7.CrossRefGoogle Scholar
  7. 7.
    Shanks M, Bertini M, Delgado V, Ng AC, Nucifora G, van Bommel RJ, et al. Effect of biventricular pacing on diastolic dyssynchrony. J Am Coll Cardiol 2010;56:1567-75.CrossRefGoogle Scholar
  8. 8.
    Cleland JGF, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-49.CrossRefGoogle Scholar
  9. 9.
    Boogers MJ, Chen J, van Bommel RJ, Borleffs CJ, Dibbets-Schneider P, van der Hiel B, et al. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2011;38:230-8.CrossRefGoogle Scholar
  10. 10.
    Khan FZ, Virdee MS, Palmer CR, Pugh PJ, O’Halloran D, Elsik M, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: The TARGET study: A randomized, controlled trial. J Am Coll Cardiol 2012;59:1509-18.CrossRefGoogle Scholar
  11. 11.
    Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol 2007;49:88-96.CrossRefGoogle Scholar
  12. 12.
    Yu CM, Zhang Q, Yip GW, Lee PW, Kum LC, Lam YY, et al. Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition. J Am Coll Cardiol 2007;49:97-105.CrossRefGoogle Scholar
  13. 13.
    Henneman MM, Chen J, Dibbets-Schneider P, Stokkel MP, Bleeker GB, Ypenburg C, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 2007;48:1104-11.CrossRefGoogle Scholar
  14. 14.
    Henneman MM, Chen J, Ypenburg C, Dibbets-Schneider P, Bleeker GB, Boersma E, et al. Phase analysis of gated myocardial perfusion single-photon emission computed tomography compared with tissue Doppler imaging for the assessment of left ventricular dyssynchrony. J Am Coll Cardiol 2007;49:1708-14.CrossRefGoogle Scholar
  15. 15.
    Trimble MA, Velazquez EJ, Adams GL, Honeycutt EF, Pagnanelli RA, Barnhart HX, et al. Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssyn-chrony. Nucl Med Commun 2008;29:374-81.CrossRefGoogle Scholar
  16. 16.
    Lin X, Xu H, Zhao X, Folks RD, Garcia EV, Soman P, et al. Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies. J Nucl Cardiol 2010;17:811-6.CrossRefGoogle Scholar
  17. 17.
    Peix A, Karthikeyan G, Massardo T, Kalaivani M, Patel C, Pabon LM, et al. Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT). J Nucl Cardiol 2019. Scholar
  18. 18.
    Rector T. Patient’s self-assessment of their congestive heart failure: Reliability and validity of a new measure-The Minnesota Living with Heart Failure Questionnaire. Heart Fail 1987;3:198.Google Scholar
  19. 19.
    Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016;23:606-39. Scholar
  20. 20.
    Boogers MJ, Chen J, Veltman CE, van Bommel RJ, Mooyaart EA, Al Younis I, et al. Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: A comparison with tissue Doppler imaging. Eur J Nucl Med Mol Imaging 2011;38:2031-9. Scholar
  21. 21.
    Marsan NA, Henneman MM, Chen J, Ypenburg C, DibbetsSchneider P, Ghio S, et al. Real-time 3-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.CrossRefGoogle Scholar
  22. 22.
    Rovner A, de Las Fuentes L, Faddis MN, Gleva MJ, Davila-Roman VG, Waggoned AR. Relation of left ventricular lead placement in cardiacresynchronization therapy to left ventricular reverse remodelingand to diastolic dyssynchrony. Am J Cardiol 2007;99:239-41.CrossRefGoogle Scholar
  23. 23.
    Fudim M, Dalgaard F, Fathallah M, Iskandrian AE, Borges-Neto S. Mechanical dyssynchrony: How do we measure it, what it means, and what we can do about it. J Nucl Cardiol 2019Google Scholar
  24. 24.
    Fudim M, Fathallah M, Shaw LK, Liu PR, James O, Samad Z, et al. The prognostic value of diastolic and systolic mechanical left ventricular dyssynchrony among patients with coronary heart disease. JACC Cardiovasc Imaging 2019;12:1215-26.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Erick Alexanderson-Rosas
    • 1
    • 2
    Email author
  • Nilda Espinola-Zavaleta
    • 1
  • Ernest V. Garcia
    • 3
  • Amalia Peix
    • 4
  • Teresa Massardo
    • 5
  • Luz M. Pabon
    • 6
  • Neftali Eduardo Antonio-Villa
    • 7
  • Isabel Carvajal-Juarez
    • 1
  • Claudio T. Mesquita
    • 8
  • Amelia Jimenez-Heffernan
    • 9
  • Chetan Patel
    • 10
  • Ganesan Karthikeyan
    • 10
  • Alka Kumar
    • 11
  • Sadaf Butt
    • 12
  • Mani Kalaivani
    • 10
  • Victor Marin
    • 13
  • Olga Morozova
    • 14
  • Diana Paez
    • 14
  1. 1.Department of Nuclear CardiologyNational Institute of Cardiology Ignacio ChavezMexico CityMexico
  2. 2.Department of Physiology, Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
  3. 3.Emory UniversityAtlantaUSA
  4. 4.Nuclear Medicine DepartmentInstitute of CardiologyLa HabanaCuba
  5. 5.Hospital Clinico Universidad de ChileSantiagoChile
  6. 6.Fundacion Valle del LiliCaliColombia
  7. 7.Facultad de MedicinaUniversidad Nacional Autonoma de MexicoMexico CityMexico
  8. 8.Hospital Universitario Antonio PedroNiteroiBrazil
  9. 9.Hospital Juan Ramon JimenezHuelvaSpain
  10. 10.All India Institute of Medical SciencesNew DelhiIndia
  11. 11.Dr. B L Kapur Memorial HospitalNew DelhiIndia
  12. 12.Oncology and Radiotherapy Institute (NORI)IslamabadPakistan
  13. 13.Fundacion CardioinfantilBogotaColombia
  14. 14.Nuclear Medicine and Diagnostic Imaging SectionInternational Atomic Energy AgencyViennaAustria

Personalised recommendations