Localization of Ventricular Tachycardia Exit Site and Subsequent Contraction Sequence and Functional Effects With Bedside Radionuclide Angiography

Botvinick, Elias H.; Davis, Jesse C.; Dae, Michael W.; O’Connell, Joe; Schechtmann, N.; Abbott, Joseph A.; Morady, Fred; Lanzer, Peter; Iskikian, J.; Scheinman, Melvin M.

doi:10.1016/j.jcmg.2008.05.013

Cited by 8 publications

(16 citation statements)

References 18 publications

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“…Planar ERNA is relatively inexpensive, widely available, and widely applied with high accuracy in virtually all patients (22). The sampling rate is sufficient to accurately measure LVEF (23), and temporal resolution is digitally enhanced and objectified by the generation of parametric images. The phase image has successfully tracked the sequence of ventricular wall motion in a variety of conduction abnormalities (15,16,(20)(21)(22)(23).…”

Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

“…The sampling rate is sufficient to accurately measure LVEF (23), and temporal resolution is digitally enhanced and objectified by the generation of parametric images. The phase image has successfully tracked the sequence of ventricular wall motion in a variety of conduction abnormalities (15,16,(20)(21)(22)(23). The ability of planar ERNA phase analysis to assess myocardial synchrony is recognized (8,12,(20)(21)(22).…”

Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

“…The ability of planar ERNA phase analysis to assess myocardial synchrony is recognized (8,12,(20)(21)(22). The SDLVØ has demonstrated the influence of synchrony on HF and CRT outcomes and was the only parameter measured in sinus rhythm, which predicted ventricular tachycardia intolerance (8,(20)(21)(22)(23). ERNA is also the only imaging method that can evaluate adequately both LVS and IVS and their combined contribution to the CRT response in patients with advanced HF.…”

Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

“…QRS duration and morphology have been shown to be predictors of response to CRT (22)(23)(24)(25). The Cardiac Resynchronization in Heart Failure study showed mortality benefit with CRT pacing alone in patients with LBBB morphology and QRS duration .…”

Section: Comparison With Ecgmentioning

confidence: 99%

“…The Cardiac Resynchronization in Heart Failure study showed mortality benefit with CRT pacing alone in patients with LBBB morphology and QRS duration . 150 ms (22)(23)(24)(25). Recent meta-analysis of CRT studies has shown that baseline QRS duration .…”

Section: Comparison With Ecgmentioning

confidence: 99%

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Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

et al. 2016

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We evaluated a novel scintigraphic method using new parameters of mechanical left ventricular (LV) dyssynchrony and correlated it with clinical outcomes in heart failure patients with reduced ejection fraction receiving cardiac resynchronization therapy (CRT). Methods: Sixty-six advanced heart failure patients referred for CRT with an LV ejection fraction (EF) of , 35% and QRS $ 120 ms were studied. We performed equilibrium radionuclide angiography (ERNA) before and 6 mo after CRT. We assessed ventricular dyssynchrony with parameters derived from the first harmonic phase (Ø) analysis of the ERNA time-activity curve and evaluated change in these parameters after 6 mo of CRT. These parameters include novel indices of synchrony (S), a measure of intraventricular contraction order, and entropy (E), a measure of intraventricular contraction disorder, and interventricular synchrony (IVS), a measure of synchronous biventricular function. Results: Forty-seven (71%) patients improved clinically (responders) at 6 mo after CRT whereas 19 (28.8%) showed no change in New York Heart Association class or worsened (nonresponders). The post-CRT changes in QRS duration (P 5 0.006), echocardiographic (P 5 0.03) and ERNA LVEF (P 5 0.0007), LVS (P 5 0.004), LVE (P 5 0.006), LV standard deviation of ventricular phase (LVSDØ) (P 5 0.004), and IVS (P 5 0.05) were significantly different between responders and nonresponders. Sixty-two percent of responders had either an LVS , 0.84 or an IVS $ 18.8°as opposed to only 16% of nonresponders (P 5 0.001). Twenty-nine of 32 (91%) patients with either of these measures responded to CRT (P , 0.01). Conclusion: LVS and IVS are novel measures of LV dyssynchrony derived from ERNA planar analysis. A baseline value of LVS , 0.84 or IVS $ 18.8°predicts a positive response to CRT.

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Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

Section: Comparison Of Other Imaging Modalitiesmentioning

confidence: 99%

Section: Comparison With Ecgmentioning

confidence: 99%

Section: Comparison With Ecgmentioning

confidence: 99%

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Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

et al. 2016

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Assessment of Cardiac Function: First-Pass, Equilibrium Blood Pool, and Gated Myocardial SPECT

Botvinick

Costouros

Bacharach

et al. 2021

Atlas of Nuclear Cardiology

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The relationship of myocardial contraction and electrical excitation—the correlation between scintigraphic phase image analysis and electrophysiologic mapping

Romeral

Stillson

Lesh³

et al. 2009

Journal of Nuclear Cardiology

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Background Phase imaging derived from equilibrium radionuclide angiography presents the ventricular contraction sequence. It has been widely but only indirectly correlated with the sequence of electrical myocardial activation. Objectives We sought to determine the specific relationship between the sequence of phase progression and the sequence of myocardial activation, contraction and conduction, in order to document a noninvasive method that could monitor both. Methods In 7 normal and 9 infarcted dogs, the sequence of phase angle was correlated with the epicardial activation map in 126 episodes of sinus rhythm and pacing from three ventricular sites. Results In each episode, the site of earliest phase angle was identical to the focus of initial epicardial activation. Similarly, the serial contraction pattern by phase image analysis matched the electrical epicardial activation sequence completely or demonstrated good agreement in approximately 85% of pacing episodes, without differences between normal or infarct groups. Conclusions A noninvasive method to accurately determine the sequence of contraction may serve as a surrogate for the associated electrical activation sequence or be applied to identify their differences.

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Localization of Ventricular Tachycardia Exit Site and Subsequent Contraction Sequence and Functional Effects With Bedside Radionuclide Angiography

Abstract: A challenging bedside imaging protocol evaluated VT-induced changes. We found that the use of ERNA demonstrated function, synchrony, and volume differences between tolerant and intolerant VT rhythms, delineated the contraction pattern, and localized exit sites.

Cited by 8 publications

References 18 publications

Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

Assessment of Cardiac Function: First-Pass, Equilibrium Blood Pool, and Gated Myocardial SPECT

The relationship of myocardial contraction and electrical excitation—the correlation between scintigraphic phase image analysis and electrophysiologic mapping

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