Gated SPECT Myocardial Perfusion Imaging, Intraventricular Synchronism, and Cardiac Events in Heart Failure

Peix, Amalia; Karell, Jorge; Rodríguez, Lydia; Cabrera, Lázaro O.; Padrón, Kenia; Carrillo, Regla; Mena, Erick; Fernández, Yoel

doi:10.1097/rlu.0000000000000428

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Our group conducted a previous study using resting gated SPECT perfusion scintigraphy on dilated cardiomyopathy patients, which also assessed perfusion, function and synchrony, but did not consider the effect of exercise on these variables. [14] It was found that presence of ischemia, SRS and phase SD were the variables that showed greatest association with adverse event occurrence during followup, which supports our current results concerning abnormal resting-phase SD.…”

Section: Discussionsupporting

confidence: 90%

“…Only 5 patients who had heart events were nonischemic, whereas 39 (89%) were ischemic. [14] The purpose of this study was to assess the value of stress-rest protocol gated SPECT-the information it provides on myocardial perfusion, ventricular function and intraventricular synchronyfor identifying symptomatic HF patients who are likely to develop adverse cardiac events.…”

Section: Introductionmentioning

confidence: 99%

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Stress–Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients

2015

MEDICC Review

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INTRODUCTIONHeart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population.OBJECTIVES Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODSA study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress-rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTSNo signifi cant differences were observed between the two groups during the stress test with regard to exercise time, metabol-ic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were signifi cantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (-1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05).CONCLUSIONS Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Stress–Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients

2015

MEDICC Review

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“…Gated-SPECT MPI can help differential diagnosis between ischemic and non-ischemic ventricular dysfunction. As it has already been shown, ischemic etiology generally causes diffuse, severe, and extensive perfusion defects in coronary artery distribution, as well as focal WM abnormalities, whereas those with non-ischemic ventricular dysfunction have either homogeneous tracer uptake or mild to moderate perfusion defects in non-coronary artery distribution, as well as diffuse WM abnormalities [31,32]. This coincides with our results, where mean SRS was signi cantly higher for ischemic patients (14.9±7.1) vs. 9±3.9 (non-ischemic) and 8.7±4.4 (non-compaction CM patients), p<0.0001.…”

Section: Discussionmentioning

confidence: 96%

Intraventricular synchronism assessment by gated - SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results?

Peix¹,

Padrón²,

Cabrera

et al. 2020

Preprint

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Purpose: To analyse the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI).Methods: Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation, and 6±1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ).Results: No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not significant. No significant differences were found at baseline regarding ventricular function, although end-diastolic volume was slightly higher in LVNC CM patients. Mean SRS was significantly higher (p<0.0001) in ischemic patients (14.9) vs. non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were significantly more dyssynchronous: their phase standard deviation (PSD) was higher (89.5±14.2 degrees) vs. groups 2 (65.2±23.3 degrees) and 3 (69.7±21.7 degrees), p=0.007. Although the quality of life significantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most significant intraventricular synchronism improvement: PSD was reduced from 89.5±14.2 degrees at baseline to 63.7±20.5 degrees post-CRT (p=0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up.Conclusion: CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.

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“…Gated-SPECT MPI contributes to the differentiation between ischemic and non-ischemic ventricular dysfunction. Ischemic dysfunction usually causes diffuse, severe, and extensive perfusion defects and wall motion abnormalities in coronary artery distribution, whereas those with non-ischemic etiology have either homogeneous tracer uptake or mild to moderate perfusion defects in non-coronary artery distribution, as well as diffuse wall motion abnormalities [32,33]. This coincides with our results, where mean SRS was significantly higher for ischemic patients (14.9 ± 7.1) versus 9 ± 3.9 (non-ischemic) and 8.7 ± 4.4 (noncompaction CM patients), p < 0.0001.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results?

Peix¹,

Padrón²,

Cabrera³

et al. 2020

EJNMMI Res

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Purpose To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI). Methods Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not significant. No significant differences were found at baseline regarding ventricular function, although end-systolic volume was slightly higher in LVNC CM patients. Mean SRS was significantly higher (p < 0.0001) in ischemic patients (14.9) versus non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were significantly more dyssynchronous: Their phase standard deviation (PSD) was higher (89.5° ± 14.2°) versus groups 2 (65.2° ± 23.3°) and 3 (69.7° ± 21.7°), p = 0.007. Although the quality of life significantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most significant intraventricular synchronism improvement: PSD was reduced from 89.5° ± 14.2° at baseline to 63.7° ± 20.5° post-CRT (p = 0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up. Conclusion CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.

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Gated SPECT Myocardial Perfusion Imaging, Intraventricular Synchronism, and Cardiac Events in Heart Failure

Abstract: A rest gated SPECT is a valid approach to identify HF patients most likely to experience cardiac events.

Cited by 12 publications

References 21 publications

Stress–Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients

Stress–Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients

Intraventricular synchronism assessment by gated - SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results?

Intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results?

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