Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload

Movahed, Mohammad Reza; Hepner, Absalom D.; Lizotte, Paul; Milne, Norah

doi:10.1016/j.nuclcard.2005.04.004

Cited by 33 publications

(23 citation statements)

References 19 publications

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“…Several findings of PHT have been reported in nuclear single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), such as flattening of the interventricular septum (D-shaped left ventricle), septal wall motion abnormalities/perfusion defect, and right ventricular (RV) enlargement or hypertrophy 2,3 . Attenuation correction (AC) of MPI with x-ray-derived attenuation maps obtained from a single-slice computer tomography scanner (CT) device has been introduced in the last years 4 .…”

Section: Introductionmentioning

confidence: 99%

Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension

Burger

Husmann

Herzog

et al. 2011

Journal of Nuclear Cardiology

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Section: Introductionmentioning

confidence: 99%

Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension

Burger

Husmann

Herzog

et al. 2011

Journal of Nuclear Cardiology

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“…The LV is crescent shaped. These findings were all attributed to PH, as described by Movahed et al 13 rather than coronary disease, because of the patient's age. However, a stress/rest polar coordinate map in this patient, compared to a normal database, would most likely show severe, partially reversible perfusion defects of the septum and apex, with a high-summed stress score.…”

Section: Next Stepsmentioning

confidence: 61%

“…12 Movahed et al retrospectively reviewed eight patients with ''straightening'' of the inter-ventricular septum on stress SPECT MPI. 13 Patients had congenital heart disease or COPD, and pulmonary pressures were less than those in the study by Gomez, ranging from 45 to 52 mm Hg measured by echo-Doppler. In addition to changes in septal conformation, patients had prominent RV visualization and RV enlargement.…”

Section: Myocardial Perfusion Imaging In Pulmonary Hypertensionmentioning

confidence: 61%

“…However, as PH becomes more pronounced, as in the group represented by Gomez et al, 12 this becomes less likely, and pharmacologic stress testing is necessary. Other than the 13 patients of Gomez et al who underwent dipyridamole stress, 12 and 5 patients of Movahed who underwent adenosine stress, 13 there is little experience reported in the literature on the safety of pharmacologic stress testing in PH.…”

Section: Pharmacologic Stress Testing Using Selective A2a Receptor Agmentioning

confidence: 99%

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Pharmacologic stress myocardial perfusion imaging in patients with pulmonary hypertension: What do we know, and what remains to be learned?

Tosh

Nichols

2018

Journal of Nuclear Cardiology

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“…Tissue Doppler imaging has been used to evaluate RV asynchrony, with speckle tracking used to measure time to peak systolic strain for the RV free wall, or four segments in the mid to basal RV on four chamber view. 26 In patients with pulmonary hypertension, scintigraphy has shown a D-shape septum and increased RV uptake of perfusion tracers, which correlates with pulmonary artery pressure, 27 and that resting RV myocardial blood flow by N-13 PET was half that of the LV. 28 Moreover, RV glucose uptake was 70% of the LV, making N-13 an attractive isotope for RV functional measurements.…”

mentioning

confidence: 99%

Ventricular asynchrony: A shift to the right?

Tosh

Nichols

2017

Journal of Nuclear Cardiology

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Evaluation of ventricular function has been a focus of nuclear medicine since 1971, when Zaret et al demonstrated that abnormalities of left ventricular (LV) wall motion and ejection fraction (EF) could be determined by injection of Tc-99m human serum albumen and acquiring images at end-diastole and end-systole. Multi-gated equilibrium radionuclide ventriculography (RNV) and first-pass imaging further refined characterization of LV asynergy and performance.2,3 Clinical trials soon showed that noninvasively determined LVEF was a strong predictor of survival in a broad range of heart diseases. 4,5 Further work demonstrated that synchronicity of LV contraction could be derived from RNV by Fourier analysis of pixel by pixel labeled RBC time-activity curves, assigning a phase to each pixel (percent of the R-R interval from 0°-360°) to identify time of maximum contraction.6 Synchronicity has important effects on LV performance: patients with inter-or intra-ventricular asynchrony have lower LVEF relative to normal control subjects.7 Mechanisms for reduced ventricular performance resulting from dyssynchrony remain unclear, but Sweeney et al suggested early-contracting segments stretch and deform later-contracting ones, and vice versa, expending energy in the process, resulting in lower rate of pressure rise, lower developed pressure, prolonged ejection, and reduced EF. 8 The most ubiquitous methods to measure asynchrony are by tissue doppler echocardiographic techniques, which use low frequency signals to measure myocardial wall deformation, and calculate strain, strain rate, delay in contraction of opposing LV walls (four basal LV segments on 4-chamber view), and dispersion of time to peak systolic contraction. 9Cardiac resynchronization therapies (CRT) were designed to improve LV synchronicity through optimally timed pacing (as determined by echo) of right ventricle (RV) and LV lateral walls. CRT promotes reverse remodeling, with improved EF and survival in heart failure patients. 10 However, clinical response to CRT (defined hemodynamically or as decrease in NYHA CHF class) occurs in only two-thirds of patients, prompting efforts to identify variables that would prospectively predict a positive CRT response. Multicenter studies (''Prospect'' and ''Rethinq'' trials) demonstrated large variability in performance of echo parameters, and their failure to predict CRT response, 11,12 which fostered the development of nuclear cardiology methods for dyssynchrony assessment.One nuclear approach to quantifying asynchrony used gated myocardial perfusion imaging (GMPI) SPECT data. 13 Because of partial volume effects, myocardial wall thickening varies linearly with systolic counts, 14 so that onset of mechanical contraction (OMC) in each LV myocardial pixel was defined as increase of systolic counts from baseline. Fourier analysis generated curves of OMC phase per pixel, plotted as frequency histograms, the standard deviation (SD) and bandwidth (BW) of which were quantified. A slightly different approach that imposes constant my...

show abstract

Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload

Cited by 33 publications

References 19 publications

Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension

Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension

Pharmacologic stress myocardial perfusion imaging in patients with pulmonary hypertension: What do we know, and what remains to be learned?

Ventricular asynchrony: A shift to the right?

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