Relation of early post-stress left ventricular dyssynchrony and the extent of angiographic coronary artery disease

Huang, Wen‐Sheng; Huang, Ching-Hui; Lee, Cheng-Liang; Chen, Ching-Pei; Hung, Guang-Uei; Chen, Ji

doi:10.1007/s12350-014-9980-7

Cited by 35 publications

(27 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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. 26 As a further validation of their initial findings, Huang et al 18 showed that early post-stress LV mechanical dyssynchrony by phase analysis of gated Tl-201 SPECT MPI is a useful tool to detect multi-vessel CAD.…”

Section: See Related Article Pp 1048-1056mentioning

confidence: 89%

“…subsequent coronary angiography were evaluated. 18 There were 57 patients with no CAD, 32 with 1-vessel disease, 36 with 2-vessel disease, and 19 with 3-vessel disease. Patients with multi-vessel CAD had significantly more global and regional LV dyssynchrony at early post-stress imaging as compared to rest.…”

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

“…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).…”

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

“…Also, dysysnchrony assessment correctly classified more patients with multi-vessel disease as compared to perfusion abnormalities and EF changes alone. 18 Using similar concept, Igarashi et al 19 showed that patients with CAD had significantly higher global changes of phase SD with stress, and were able to differentiate patients with heart failure as ischemic vs non-ischemic etiologies. The ability to detect and quantify regional LV mechanical dyssynchrony is obviously a leap forward in the technique of phase analysis and has several advantages and clinical utilities (Table 1).…”

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

See 3 more Smart Citations

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

AlJaroudi

2014

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

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...

show abstract

Section: See Related Article Pp 1048-1056mentioning

confidence: 89%

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

Section: See Related Article Pp 1048-1056mentioning

confidence: 99%

See 2 more Smart Citations

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

AlJaroudi

2014

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

show abstract

“…3, 4 Aljaroudi 5 outlined other potential clinical applications of LVD including prognostication and risk stratification of patients with ischemic, 6 non-ischemic cardiomyopathy, 7 implantable defibrillators 8 , and end-stage renal disease. 9,10 Several studies have demonstrated the relation of LVD with myocardial ischemic and/or scar burden, [11][12][13] coronary artery disease (CAD) extent 14 , and LV contractile function. 15 However, there are conflicting data in the literature about the effect of different patterns of perfusion abnormality on LVD in CAD patients.…”

mentioning

confidence: 99%