Nonechocardiographic Imaging in Evaluation for Cardiac Resynchronization Therapy

Myocardial perfusion imaging (MPI) has become a preeminent molecular imaging technique to assess ventricular mechanical dyssynchrony. In this article, we outline the motivation for the assessment of dyssynchrony, briefly review the application of echocardiographic and other non-nuclear imaging techniques for that purpose, and detail the technical aspects and validation of phase analysis by gated single-photon computed emission tomography and positron emission tomography. We also briefly outline differences between phase analysis of MPI and radionuclide angiography. Clinical applications are then reviewed, focusing on cardiac resynchronization therapy.

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“…For a more complete discussion of the evaluation for CRT using non-echocardiographic techniques, we refer the reader to a recent review [18].…”

Section: Magnetic Resonance Imaging and X-ray Computed Tomographymentioning

confidence: 99%

Imaging cardiac dyssynchrony

Kriekinge

Germano

2013

Clin Transl Imaging

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“…6 The more stringent QRS threshold for CRT implementation was meant to choose patients with greater electrical dyssynchrony, thus greater mechanical dyssynchrony, and therefore those with higher chance of CRT restoring synchronicity of myocardial contraction. However, electrical and mechanical dyssynchrony are not interchangeable, 7,8 which explains in part the remaining high rate of non-responders. 9 Because of its non-invasiveness, low cost, and wide availability, significant effort and research were placed on identifying mechanical dyssynchrony parameters with echocardiography that would be best predictive of CRT response.…”

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confidence: 99%

“…12 Unlike echocardiography, SPECT myocardial perfusion imaging (MPI) provides a single parameter to define mechanical dyssynchrony (phase analysis derived standard deviation SD) which is reproducible, repeatable on serial imaging testing, and easy to derive. 8 Shortly after, Henneman et al showing that a phase SD [ 43°was an independent predictor of CRT response. 13 In the following years, significant data were published on phase analysis and mechanical dyssynchrony.…”

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confidence: 99%

“…8,18 Fortunately, both parameters are well defined with SPECT MPI. In a pioneer and well done prospective single-center study, Friehling et al showed that an algorithm incorporating the presence of baseline mechanical dyssynchrony with phase analysis, limited myocardial scar burden, and LV lead concordance with area of latest onset mechanical contraction predicted response to CRT.…”

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confidence: 99%

“…During the same period, there has been several papers evaluating the role of cardiac computed tomography (CCT) and magnetic resonance (CMR) in guiding patient selection and predicting CRT response, whether by identifying scar burden, mechanical dyssynchrony, and coronary vein anatomy for best LV lead placement 8 ( Fig. 1).…”

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Mechanical dyssynchrony with phase analysis of gated SPECT: Nap time is over

AlJaroudi

2018

Journal of Nuclear Cardiology

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Cardiac resynchronization therapy (CRT) improves left ventricular (LV) remodeling, quality of life, and survival among patients with heart failure and reduced ejection fraction (EF \ 35%) and electrical dyssynchrony (wide QRS duration). [1][2][3] However, a significant proportion of patients do not derive the expected benefit from such expensive and invasive procedure. 4 In 2011, Goldengerb et al. identified 7 factors from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial that improved patient selection and predicted better CRT response; 5 these included female gender, non-ischemic cardiomyopathy, left bundle branch block (LBBB), QRS C 150 ms, prior hospitalization for heart failure, left ventricular end-diastolic volume index C 125 ml/m 2 , and left atrial volume index less than 40 ml/m 2 . Shortly after, the 2012 guidelines for CRT implantation were updated and recommended CRT for patients with EF B 35%, NYHA class C II with LBBB, and QRS C 150 ms (the only class I indication) as compared to a QRS threshold C 120-130 ms with 2008 guidelines. 6 The more stringent QRS threshold for CRT implementation was meant to choose patients with greater electrical dyssynchrony, thus greater mechanical dyssynchrony, and therefore those with higher chance of CRT restoring synchronicity of myocardial contraction. However, electrical and mechanical dyssynchrony are not interchangeable, 7,8 which explains in part the remaining high rate of non-responders. 9 Because of its non-invasiveness, low cost, and wide availability, significant effort and research were placed on identifying mechanical dyssynchrony parameters with echocardiography that would be best predictive of CRT response. Indeed, an exponential increase in the number of research papers was observed in the field of echocardiography between 2004 and 2008 exploring dozen of parameters with 2D, 3D echocardiography, strain, strain rate, and many others (Fig. 1). Promising single-center data were published, while others had conflicting data, until the negative and conclusive results of PROSPECT trial, a multicenter study that tested many echocardiography parameters (interobserver and intraobserver variability 4%-24% and 7%-72%, respectively) all of which failed to predict CRT response. 10 Shortly thereafter, interest in mechanical dyssynchrony with echocardiography took a significant hit, and despite recent efforts to revive it, 11 the number of publications kept on declining dramatically (Fig. 1).In 2005, Chen et al. published one of the first papers on mechanical dyssynchrony using phase analysis concept from gated single-photon emission computed tomography (SPECT). 12 Briefly, a 3D count distribution is extracted from each of the LV short-axis datasets; a 1D fast Fourier transform is applied to the count variation over time for each voxel, generating a 3D phase distribution that describes the timing of LV onset of mechanical contraction over the entire R-R cycle. 12 Unlike echocardiography, SPECT myocardial...

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New Image Integration Technologies for Optimization of Cardiac Resynchronization Therapy

Eitel

Piorkowski

2012

Cardiac Mapping

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Nonechocardiographic Imaging in Evaluation for Cardiac Resynchronization Therapy

Cited by 29 publications

References 93 publications

Imaging cardiac dyssynchrony

Imaging cardiac dyssynchrony

Mechanical dyssynchrony with phase analysis of gated SPECT: Nap time is over

New Image Integration Technologies for Optimization of Cardiac Resynchronization Therapy

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