Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

AlJaroudi, Wael; Koneru, Jayanth; Heo, Jaekyeong; Iskandrian, Ami E.

doi:10.1007/s12350-010-9296-1

Cited by 75 publications

(57 citation statements)

References 17 publications

(23 reference statements)

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“…This technique is called phase analysis (4). Previous studies (11) have shown that phase analysis is a valuable tool for patient management and diagnosis, especially in cases of heart failure. Another study demonstrated that phase analysis also has incremental value for evaluating ischemic heart disease using thallium-based exercise-induced stress MPI (5).…”

Section: Discussionmentioning

confidence: 99%

Can Stress-induced Phase Change be Observed on <sup>99m</sup>Tc Pharmacological Stress Myocardial Perfusion Imaging?

Myssayev

Ideguchi

Chiba

et al. 2018

Annals of Nuclear Cardiology

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Section: Discussionmentioning

confidence: 99%

Can Stress-induced Phase Change be Observed on <sup>99m</sup>Tc Pharmacological Stress Myocardial Perfusion Imaging?

Myssayev

Ideguchi

Chiba

et al. 2018

Annals of Nuclear Cardiology

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“…Late post-stress imaging (30-60 minutes), as is the case with Tc-99m SPECT imaging, often results in recovery of LV stunning with no residual detectable change in LV dyssynchrony (stress vs rest) at the time of imaging, even in the presence of large ischemic burden. 24,25 On the other hand, early post-stress imaging that is more feasible with Tl-201 (5-10 minutes) captures stress-induced changes in LV dyssynchrony. 26 Indeed, dyssynchronous contraction in the ischemic region during peak stress, leads to deterioration of LV synchrony as opposed to the normal myocardium that retains its synchrony.…”

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

Early post-stress LV dyssynchrony: A new marker for significant CAD

AlJaroudi

2014

Journal of Nuclear Cardiology

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Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) remains one of the most commonly ordered tests for the detection of ischemia and significant coronary artery disease (CAD). 1 A coronary artery territory perfused by a significantly narrowed vessel has limited coronary flow reserve; hence, during peak stress, there are less blood flow and tracer uptake in that region as compared to normal myocardial. The detection of reversible perfusion defect, therefore, depends on the relative flow between myocardial territories. 2 In patients with multivessel disease, the coronary flow reserve is reduced in all territories leading to what has been described as balanced ischemia phenomenon. 3 The latter poses a challenge as patients with multi-vessel CAD may have ''normal'' MPI and could be miss-diagnosed or more commonly assumed to have less extensive CAD. 3 However, other complementary tools have helped recognize the presence of high ischemic burden even when the perfusion images say otherwise. Among them, transient ischemic dilation (TID), 4 increased lung uptake of 5 and left ventricular (LV) stunning (i.e., decrease in early post-stress LV ejection fraction [EF]). These tools, nevertheless, have limitations: the diagnostic accuracy of TID is low; Tl-201 is rarely used and has been replaced by Tc-99m; and LV stunning is often missed or underestimated since imaging with SPECT does not occur at peak stress giving enough time for LV recovery. 6 LV mechanical dyssynchrony indices have been proposed as additional tools to help detect myocardial stunning and ischemia-induced dyssynchronous contraction. The technique was developed by Chen 7 almost a decade ago. It calculates a phase value for each of sampled regions ([600) that represent the onset of mechanical contraction. The standard deviation (phase SD) and 95% bandwidth (histogram bandwidth) represent the LV dyssynchrony indices: the bigger the numbers, the greater the dyssychrony. These indices are derived retrospectively from prior acquired and saved images, with no additional radiation burden or cost. They are automated, reproducible with small inter and intra-observer variability, 8 repeatable, 9 and have been validated against two 10 and three-dimensional echocardiography. 11 The initial application of the technique was in identifying the optimal patients with cardiomyopathy who would derive most benefit from cardiac resynchronization therapy. 12 Since then, the technique proved not only to be a valuable tool in detecting mechanical dyssynchrony, but also providing prognostic information and risk stratifying patients with various co-morbidities (ischemic, 13 non-ischemic cardiomyopathy, 14 implantable defibrillators, 15 end-stage renal disease 16,17 ). More recently, the technique has been used to detect ischemiainduced myocardial dyssynchrony and multi-vessel CAD by comparing stress and rest indices [18][19][20] (Table 1).The concept of stress-induced changes in LV dyssynchrony is not new. In patients with normal MPI undergoing gated...

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“…In a small study, the presence of reversible perfusion defect did not alter the indices of mechanical dyssynchrony by phase analysis from gated SPECT; however, there was no angiographic data to correlate with anatomic stenosis. 11 In a more recent study, patients with multi-vessel CAD confirmed with angiography had significantly more global and territorial dyssynchrony at early post-stress than at rest 201-Thallium SPECT MPI. 12 Another study measured LV synchrony immediately after reperfusion therapy using real-time three-dimensional echocardiography and showed strong correlation with 201-Thallium and 123I-beta methyl-iodophenyl pentadecanoic acid mismatch with dual isotope SPECT, a reflection of acute myocardial stunning.…”

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confidence: 93%

Myocardial stunning by gated SPECT: An old tool reinvented in a stunning turn

AlJaroudi

Hage

2019

Journal of Nuclear Cardiology

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Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

Abstract: The presence of even a large reversible perfusion defect does not alter the indices of mechanical dyssynchrony by phase analysis. Further, comparable information is obtained whether using a low dose or a high dose of the radiotracer.

Cited by 75 publications

References 17 publications

Can Stress-induced Phase Change be Observed on <sup>99m</sup>Tc Pharmacological Stress Myocardial Perfusion Imaging?

Can Stress-induced Phase Change be Observed on <sup>99m</sup>Tc Pharmacological Stress Myocardial Perfusion Imaging?

Early post-stress LV dyssynchrony: A new marker for significant CAD

Myocardial stunning by gated SPECT: An old tool reinvented in a stunning turn

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