SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony

Chen, Ji; Garcia, Ernest; Bax, Jeroen J.; Iskandrian, Ami E.; Borges‐Neto, Salvador; Soman, Prem

doi:10.1007/s12350-011-9392-x

Cited by 112 publications

(78 citation statements)

References 57 publications

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“…More recently, parameters of LV mechanical dyssynchrony derived by phase analysis of MPS have been validated, adding yet another facet to the spectrum of functional information provided. 1 A unique attribute of SPECT is that it is largely automated, and thus, has excellent precision (reproducibility and repeatability). However, several factors need to be controlled, to achieve optimum precision of SPECT functional data including the injected dose, timing of image acquisition after injection, background activity, and filter characteristics.…”

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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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“…2,3 The commonly used clinical parameters from phase analysis include peak phase (PP), phase standard deviation (PSD), phase bandwidth (PBW), phase histogram skewness, and phase histogram kurtosis. The normal databases consisted of PP (134.5°± 14.3°for men and 140.2°± 14.9°for women), PSD (14.2°± 5.1°for men and 11.8°± 5.2°for women), PBW (38.7°± 11.8°for men and 30.6°± 9.6°for women), skewness (4.19 ± 0.68 for men and 4.60 ± 0.72 for women), and kurtosis (19.72 ± 7.68 for men and 23.21 ± 8.16 for women).…”

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Left-ventricular mechanical dyssynchrony in the prognosis of dilated cardiomyopathy: Which parameter is more useful?

Zhou

Hung

2018

Journal of Nuclear Cardiology

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Since the invention of the phase analysis technique from ECG-gated myocardial perfusion SPECT by Chen et al in 2005,1 it has been widely used to measure leftventricular mechanical dyssynchrony (LVMD). Briefly, the phase analysis technique applies a one-dimensional First-harmonic Fourier approximation to the count variation over cardiac frames for each myocardial region on nuclear images and thus generates a 3D phase distribution that describes the timing of LV onset of mechanical contraction over the entire R-R cycle.1,2 The technique is fully automated, and has effective temporal resolution of *15 ms for a heart rate of 60/minute, high inter-and intra-observer reproducibility, good robustness with camera types, tracer dose, heart rate, and perfusion defects. 2,3The commonly used clinical parameters from phase analysis include peak phase (PP), phase standard deviation (PSD), phase bandwidth (PBW), phase histogram skewness, and phase histogram kurtosis. The normal databases consisted of PP (134.5°± 14.3°for men and 140.2°± 14.9°for women), PSD (14.2°± 5.1°for men and 11.8°± 5.2°for women), PBW (38.7°± 11.8°for men and 30.6°± 9.6°for women), skewness (4.19 ± 0.68 for men and 4.60 ± 0.72 for women), and kurtosis (19.72 ± 7.68 for men and 23.21 ± 8.16 for women).1 The LVMD parameters have been shown to correlate well with those by tissue Doppler imaging (TDI) echocardiography. 4,5 Henneman et al 4 found that PSD and PWB by phase analysis from SPECT correlated well with LVMD assessed with 2D TDI (r = 0.80, P \ 0.0001 and r = 0.89, P \ 0.0001, respectively); histogram skewness and kurtosis correlated less well with LVMD on 2D TDI (r = -0.52, P \ 0.0001 and r = -0.45, P \ 0.0001, respectively). Marsan et al 5 found that PSD and PBW showed good correlation with 3D TDI (r = 0.74, P \ 0.0001 and r = 0.77, P \ 0.0001, respectively); histogram skewness showed a poor correlation with 3D TDI (r = -0.30, P = 0.06); there was no correlation between histogram kurtosis and 3D TDI (r = -0.14, P = 0.38). PSD and PBW showed the best correlation with the dyssynchrony assessed with echo; hence, they are more commonly used to report the LVMD from gated myocardial perfusion SPECT.Furthermore, PSD and PBW have been extensively used for the patient selection and prognosis of cardiovascular diseases. In a study with 42 cardiac resynchronization therapy (CRT) patients, 6 it was demonstrated that responders (71%) and non-responders (29%) had comparable baseline characteristics, except for PSD (56.3°± 19.9°vs. 37.1°± 14.4°, P \ 0.01) and PBW (175°± 63°vs. 117°± 51°, P \ 0.01), which were significantly larger in responders compared with non-responders. Moreover, the receiver operating characteristic (ROC) curve analysis demonstrated an optimal cutoff value of 43°for PSD (sensitivity and specificity of 74%) and of 135°for PBW (sensitivity and specificity of 70%) for the prediction of CRT response. In a study with 22 patients who had irreversible ischemic cardiomyopathy and received CRT for at least 12 months, 7 it was found that PBW was an inde...

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“…4 Several studies have tried to address one or more of these questions using different imaging modalities. [5][6][7] Ideal imaging modality will have high spatial and temporal resolution to accurately identify the latest contracting segment, will give the implanting physician information about myocardial viability, coronary venous anatomy, and will have high degree of automation and reproducibility. Single-Photon Emission Computed Tomography (SPECT), Echocardiography, and Cardiac Magnetic Resonance Imaging (CMR) all have been evaluated for this purpose and each has its own limitation.…”

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Is it time for personalized cardiac resynchronization therapy

Kumar

2018

Journal of Nuclear Cardiology

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Cardiac resynchronization therapy (CRT) in appropriately selected patients can significantly improve left ventricular function and New York Heart Association (NYHA) class. 1-3 CRT trials' inclusion criteria have been based solely on QRS duration with left ventricular (LV) lead implantation in the posterolateral branch of the coronary sinus as the preferred location. Using these guidelines, 60-70% of the CRT recipients respond with improvement in symptoms and/or ejection fraction. Response rate is much higher in individuals with typical left bundle branch block (LBBB) QRS morphology, with QRS duration [150 msec and nonischemic cardiomyopathy. In those who lack these criteria response rate to CRT has been poor. The reason for this poor response rate is multifold including lack of dyssynchrony, presence of scar at the site of lead implantation, and inappropriate LV lead position. To overcome these challenges and improve patient response, implanting physician will benefit from the following information: (1) Is there the presence of significant dyssynchrony? (2) Which is the most dyssynchronous segment of the left ventricle? (3) Can that segment be accessed and used for pacing? This information will be most useful in patients with intraventricular conduction delay (IVCD) and atypical LBBB like QRS pattern rather than typical LBBB. In the presence of typical LBBB, latest activating segment is posterolateral basal left ventricle (LV) and there is usually significant dyssynchrony. 4 Several studies have tried to address one or more of these questions using different imaging modalities. [5][6][7] Ideal imaging modality will have high spatial and temporal resolution to accurately identify the latest contracting segment, will give the implanting physician information about myocardial viability, coronary venous anatomy, and will have high degree of automation and reproducibility. Single-Photon Emission Computed Tomography (SPECT), Echocardiography, and Cardiac Magnetic Resonance Imaging (CMR) all have been evaluated for this purpose and each has its own limitation. There is disagreement on which echocardiographic parameter to use for dyssynchrony assessment and reproducibility has been poor. The largest trial using echocardiographic dyssynchrony assessment-guided CRT placement was negative 6 although the inclusion criteria included only narrow QRS patients. Phase analysis from gated SPECT imaging has been proposed as a relatively straightforward way of assessing dyssynchrony. 8 It uses Fourier harmonic function to approximate change in thickness of myocardium during a cardiac cycle to onset of contraction. This information of phase of onset of contraction is displayed on a polar map. Phase standard deviation and phase histogram bandwidth can then be used to quantify dyssynchrony and also to identify the latest contracting segments. This can then be combined with viability assessment and potentially fused with coronary sinus venograms, 9 thereby providing a road map for precise and individualized LV lead placement.The curren...

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SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony

Cited by 112 publications

References 57 publications

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

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

Left-ventricular mechanical dyssynchrony in the prognosis of dilated cardiomyopathy: Which parameter is more useful?

Is it time for personalized cardiac resynchronization therapy

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