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Relationships between left ventricular asynchrony and myocardial blood flow

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

82Rb PET protocols enable determination of left ventricular asynchrony (LVAS) at rest and stress, along with myocardial blood flow (MBF). We hypothesized that in patients with resting LVAS, MBF differs between those with stress-induced LVAS improvement and those with stress-induced LVAS deterioration.

Methods

We retrospectively analyzed 82Rb rest/regadenoson stress PET studies of 195 patients evaluated for known or suspected coronary artery disease. MBF was computed from first-pass data; function and relative perfusion were computed from myocardial equilibrium data. LVAS was defined as phase contraction bandwidth (BW) above 82Rb gender-specific normal limits, with changes defined as BW moving into or out of normal ranges.

Results

Among the 195 patients, 64 had LVAS at rest, of whom 13 reverted to normal and 51 continued to have LVAS with stress. Patients who did not improve had lower stress MBF (1.04 ± 0.69 vs 1.58 ± 0.67, p = .02) and coronary flow reserve (1.94 ± 1.16 vs 3.04 ± 1.22, p = .01) than those who did improve. ROC analysis indicated that the parameter most strongly associated with improvement in asynchrony for patients with resting LVAS was reduction in MBF heterogeneity (ROC area (accuracy) = 84%, sensitivity = 92%, and specificity = 67%).

Conclusion

LVAS is highly correlated with MBF and CVR, with stress-induced improvement in synchronicity most strongly associated with improved MBF homogeneity.

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Abbreviations

CFR:

Coronary flow reserve

CRT:

Cardiac resynchronization therapy

CVR:

Coronary vascular resistance

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

LV:

Left ventricle

LVAS:

Left ventricular asynchrony

MBF:

Myocardial blood flow

OSEM:

Ordered subset expectation maximization

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Disclosures

Co-authors John R. Votaw, C. David Cooke, and Kenneth J. Nichols participate in royalties from Syntermed, Inc., in relation to some of the algorithms discussed in this manuscript. This work was supported in part by a Grant from NIH, R01HL085417-04.

Author information

Authors and Affiliations

  1. Research Department, St. Francis Hospital, Roslyn, NY, USA

    Andrew Van Tosh MD & Nathaniel Reichek MD

  2. Department of Radiology, Emory University, Atlanta, GA, USA

    John R. Votaw PhD & C. David Cooke MSSE

  3. Division of Nuclear Medicine and Molecular Imaging, North Shore - Long Island Jewish Health System, Manhasset & New Hyde Park, NY, USA

    Christopher J. Palestro MD & Kenneth J. Nichols PhD

  4. Division of Cardiovascular Research, St. Francis Hospital - The Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA

    Andrew Van Tosh MD

Authors
  1. Andrew Van Tosh MD
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  2. John R. Votaw PhD
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  3. C. David Cooke MSSE
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  4. Nathaniel Reichek MD
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  5. Christopher J. Palestro MD
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  6. Kenneth J. Nichols PhD
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Corresponding author

Correspondence to Andrew Van Tosh MD.

Additional information

See related editorial, doi:10.1007/s12350-015-0292-3.

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Van Tosh, A., Votaw, J.R., Cooke, C.D. et al. Relationships between left ventricular asynchrony and myocardial blood flow. J. Nucl. Cardiol. 24, 43–52 (2017). https://doi.org/10.1007/s12350-015-0270-9

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  • DOI: https://doi.org/10.1007/s12350-015-0270-9

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