Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies

Lin, Xianhe; Xu, Huiling; Zhao, Xuefeng; Folks, Russell; Garcia, Ernest; Soman, Prem; Chen, Ji

doi:10.1007/s12350-010-9238-y

Cited by 78 publications

(35 citation statements)

References 20 publications

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“…There is only sparse data on the repeatability of SPECT-derived dyssynchrony parameters. 11,12 In this issue of the journal, Nakajima and colleagues report a study comparing the dyssynchrony indices obtained from four software programs for processing gated SPECT data. 13 Only two of these programs are available in the United States (QGS and ECTb), and they are widely used here.…”

Section: See Related Article Pp 611-621mentioning

confidence: 99%

Software-dependent processing variability in SPECT functional parameters: Clinical implications

Malhotra

2017

Journal of Nuclear Cardiology

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Section: See Related Article Pp 611-621mentioning

confidence: 99%

Software-dependent processing variability in SPECT functional parameters: Clinical implications

Malhotra

2017

Journal of Nuclear Cardiology

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“…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.…”

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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“…(i) Differences between software packages and applied algorithms to calculate LVEF; 1,2,4,12 (ii) Human detection inaccuracies of the true end systole and end diastole images; 1,13 (iii) Differences in software edge-detection algorithms;…”

Section: Introductionmentioning

confidence: 99%

A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

2015

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Purpose: A planar multi-gated cardiac blood pool acquisition is a non-invasive technique commonly used to measure left ventricular ejection fraction (LVEF).It is essential that the calculation of LVEF be accurate, repeatable and reproducible for serial monitoring of patients. Different processing modes may be used in calculating the LVEF which require various degrees of manipulation.In addition, different operators with varying levels of experience may process the same data set. It is not known whether the inter-operator variability of LVEF values within a single nuclear medicine department has the potential to affect the calculated LVEF and in turn affect patient management. The aim of the study was to determine variability of LVEF values among operators with different levels of experience using two processing modes.Methods: A descriptive cross-sectional study was carried out in a single setting.Four operators with varying levels of experience analysed 120 left anterior oblique projections using manual and automatic processing modes to calculate the LVEF. Inter-and intra-operator correlation was determined.Results: Manual processing showed moderate to strong agreement (r1=0.653) between operators. Automatic processing indicated almost perfect (r1=0.812) inter-operator correlation. Intra-operator correlation demonstrated a trend of decreasing variability between processing modes with increasing levels of experience. Conclusion:Despite the overall inter-operator agreement, significant intraoperator variability was evident in results from operators with less experience.However, the discrepancies were such that the differences in LVEF would not 3 play a role in patient management. It is recommended that automatic processing be used for determining LVEF to limit inter-operator variability.Additionally operator experience should be considered in the absence of standardised processing protocols when different processing modes are available in a single setting.

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Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies

Abstract: Background-The purpose of this study was to establish the repeatability of left-ventricular (LV) dyssynchrony and function parameters measured from serial gated myocardial perfusion SPECT (GMPS) studies.

Cited by 78 publications

References 20 publications

Software-dependent processing variability in SPECT functional parameters: Clinical implications

Software-dependent processing variability in SPECT functional parameters: Clinical implications

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

A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

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