Journal of Nuclear Cardiology

, Volume 24, Issue 1, pp 122–129 | Cite as

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

  • Nili Zafrir
  • Tamir Bental
  • Boris Strasberg
  • Alejandro Solodky
  • Israel Mats
  • Ariel Gutstein
  • Ran Kornowski
Original Article



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.


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.


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.


MLVD by phase SD can identify patients with cardiac events and predict cardiac death in patients treated with ICD.


Mechanical left ventricular dyssynchrony gated SPECT MPI phase SD CRT-D ICD cardiac outcome 



Cardiac resynchronization therapy with a defibrillator


Implantable cardiac defibrillator


Left ventricular ejection fraction


Mechanical left ventricular dyssynchrony


Myocardial perfusion imaging


New York Heart Association


Single-photon emission computed tomography




Ventricular tachycardia/ventricular fibrillation


Heart failure


Standard deviation


Conflict of interest

The authors report no potential conflict of interest relevant to this article.


  1. 1.
    Leclercq C, Kass DA. Retiming the failing heart: Principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol 2002;39:194-201.CrossRefPubMedGoogle Scholar
  2. 2.
    Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation 2003;108:2596-603.CrossRefPubMedGoogle Scholar
  3. 3.
    Leclercq C, Hare JM. Ventricular resynchronization: current state of the art. Circulation 2004;109:296-9.CrossRefPubMedGoogle Scholar
  4. 4.
    Abraham WT, Fiber WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Eng J Med 2002;346:1845-53.CrossRefGoogle Scholar
  5. 5.
    Chung ES, Leon AR, Tavazzi L, Sun JP, Merlino J, Abraham WT, et al. Results of the predictor of response to cardiac resynchronization therapy (PROSPECT) trial. J Cardiol Failure 2007;13:793.CrossRefGoogle Scholar
  6. 6.
    Fisher JD, Buxton AE, Lee KL, Packer DL, Echt DS, Denes P, et al. MUSTT Events Committee. Designation and distribution of events in the Multicenter Unsustained Tachycardia Trial (MUSTT). Am J Cardiol 2007;100:76-83.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877-83.CrossRefPubMedGoogle Scholar
  8. 8.
    Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834-40.CrossRefPubMedGoogle Scholar
  9. 9.
    Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, et al. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238-40.CrossRefPubMedGoogle Scholar
  10. 10.
    Penicka M, Bartunek J, Lang O, Medilek K, Tousek P, Vanderheyden M, et al. Severe left ventricular dyssynchrony is associated with poor prognosis in patients with moderate systolic heart failure undergoing coronary artery bypass. J Am Coll Cardiol 2007;50:1315-23.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Henneman MM, Chen J, Dibbets-Schneider P, Dibbets-Schneider P, Stokkel MP, Bleeker GB, et al. Can LV dyssychrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 2007;48:1104-11.CrossRefPubMedGoogle Scholar
  13. 13.
    Boogers MM, Van Kriekinge SD, Hennemam MM, Ypenburg C, Van Bommel RJ, Boersma E, et al. Quantitative gates SPECT derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy. J Nucl Med 2009;50:718-25.CrossRefPubMedGoogle Scholar
  14. 14.
    Samad Z, Atchley AE, Trimble MA, Sun JL, Shaw LK, Pagnanelli R, et al. Prevalence and predictors of mechanical dyssynchrony as defined by phase analysis in patients with left ventricular dysfunction undergoing gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2011;18:24-30.CrossRefPubMedGoogle Scholar
  15. 15.
    Pazhenkottil AP, Buechel RR, Husmann L, Nkoulou RN, Wolfrum M, Ghadri JR, et al. Long-term prognostic value of left ventricular dyssyncriny assessment by phase analysis from myocardial perfusion imaging. Heart 2011;97:33-7.CrossRefPubMedGoogle Scholar
  16. 16.
    Uebleis C, Hellweger S, Laubender RP, Becker A, Shon HY, Lehner S, et al. Left ventricular dyssynchrony assessed by gated SPECT phase analysis in an independent predictor of death in patients with advanced coronary artery disease and reduced left ventricular function not undergoing cardiac resynchronization therapy. Eur J Nucl Med Mol Imaging 2012;39:1561-9.CrossRefPubMedGoogle Scholar
  17. 17.
    Zafrir N, Nevzorov R, Bental T, Strasberg B, Gutstein A, Mats I, et al. Prognostic value of left ventricular dyssynchrony by myocardial perfusion gated SPECT in patients with normal and abnormal left ventricular function. J Nucl Cardiol 2014;21:532-40.CrossRefPubMedGoogle Scholar
  18. 18.
    Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkatarama R, Heo J, et al. Relation of left ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010;17:298-304.CrossRefGoogle Scholar
  19. 19.
    Friehling M, Chen J, Saba S, Bazaz R, Scharrzman D, Adelstein EC, et al. A prospective pilot study to evaluate the relationship between acute change in left ventricular synchrony after cardiac resynchronization therapy and predict outcome using a single injection gated SPECT protocol. Circ Cardiovasc Imaging 2011;4:532-9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Nili Zafrir
    • 1
  • Tamir Bental
    • 1
  • Boris Strasberg
    • 1
  • Alejandro Solodky
    • 1
  • Israel Mats
    • 1
  • Ariel Gutstein
    • 1
  • Ran Kornowski
    • 1
  1. 1.Cardiology DepartmentRabin Medical CenterPetah TiqvaIsrael

Personalised recommendations