Usefulness of quantitative gated single-Photon emission computed tomography to evaluate ventricular synchrony in patients receiving biventricular pacing

Tsurugaya, Hideki; Tada, Hiroshi; Toyama, Takuji; Naito, Shigeto; Adachi, Hitoshi; Seki, Ryotaro; Nogami, Akihiko; Hara, Hiroshi; Kurabayashi, Masahiko; Taniguchi, Koichi

doi:10.1016/j.amjcard.2004.03.044

Cited by 7 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tsurugaya et al (26) have reported on quantitative gated SPECT before and after CRT in 10 heart failure patients. At a follow-up of 18 6 6 mo, patients were classified as responders or nonresponders according to their clinical status and echocardiographic parameters.…”

Section: Discussionmentioning

confidence: 99%

Can LV Dyssynchrony as Assessed with Phase Analysis on Gated Myocardial Perfusion SPECT Predict Response to CRT?

Henneman¹,

Chen²,

Dibbets‐Schneider³

et al. 2007

Journal of Nuclear Medicine

270

205

View full text Add to dashboard Cite

Cardiac resynchronization therapy (CRT) is now a well-recognized therapeutic option for patients with end-stage heart failure. However, not all patients respond to CRT, and, therefore, preimplantation identification of responders is desirable. The aim of the present study was to investigate whether the degree of left ventricular (LV) dyssynchrony, as assessed with phase analysis from gated myocardial perfusion SPECT (GMPS), can predict which patients will respond to CRT. Methods: Forty-two patients with severe heart failure, depressed LV ejection fraction, and wide QRS complex were prospectively included for implantation of a CRT device and underwent GMPS and 2-dimensional echocardiography as part of the clinical protocol. Clinical status was evaluated using the New York Heart Association (NYHA) classification, 6-min walk test, and quality-of-life score. The histogram bandwidth and phase SD (parameters indicating LV dyssynchrony) were assessed from GMPS, and the clinical status and echocardiographic variables were reassessed at 6-mo followup. Results: Responders (71%) and nonresponders (29%) had comparable baseline characteristics, except for histogram bandwidth (175°6 63°vs. 117°6 51°[P , 0.01]) and phase SD (56.3°6 19.9°vs. 37°.1 6 14.4°[P , 0.01]), which were significantly larger in responders compared with nonresponders. Moreover, receiver-operating-characteristic curve analysis demonstrated an optimal cutoff value of 135°for histogram bandwidth (sensitivity and specificity of 70%) and of 43°for phase SD (sensitivity and specificity of 74%) for the prediction of response to CRT. Conclusion: Response to CRT is related to the presence of LV dyssynchrony assessed by phase analysis with GMPS. A cutoff value of 135°for histogram bandwidth and of 43°for phase SD could be used to predict response to CRT. Larger prospective studies are warranted to confirm the present findings.Key Words: left ventricular dyssynchrony; cardiac resynchronization therapy; SPECT; heart failure J Nucl Med 2007; 48: 1104 -1111 DOI: 10.2967 In the recent years, cardiac resynchronization therapy (CRT) has emerged as a new treatment strategy for a subgroup of patients with end-stage heart failure, a depressed left ventricular ejection fraction (LVEF), and wide QRS complex on the surface electrocardiogram (.120 ms) (1). Although initial studies reported promising results, approximately 20%-30% of the patients do not respond to CRT (1-4). Recent data have indicated that LV dyssynchrony may be mandatory for response to CRT (5,6). A wide QRS complex may not adequately indicate LV dyssynchrony, as 30% of the patients with a wide QRS complex (.120 ms) do not have substantial LV dyssynchrony on echocardiography whereas, on the other hand, approximately one third of the patients with a narrow QRS appear to have substantial LV dyssynchrony on echocardiography (7,8).At present, various imaging techniques are available for the assessment of LV dyssynchrony, including echocardiography with tissue Doppler imaging (TDI), or strain imaging, and MRI (9,10...

show abstract

Section: Discussionmentioning

confidence: 99%

Can LV Dyssynchrony as Assessed with Phase Analysis on Gated Myocardial Perfusion SPECT Predict Response to CRT?

Henneman¹,

Chen²,

Dibbets‐Schneider³

et al. 2007

Journal of Nuclear Medicine

270

205

View full text Add to dashboard Cite

show abstract

“…Using a dynamic display of the onset of mechanical contraction, this method could be potentially helpful for selecting those patients in whom the degree of left ventricular dyssynchrony is predictive of a favourable response to resynchronisation therapy [125]. Tsurugaya et al could classify patients into responders and non-responders to biventricular pacing on the basis of the improvement in left ventricular synchrony assessed by gated SPECT studies performed before and shortly after the onset of cardiac resynchronisation therapy [126]. To this end they used a simplified approach based on an asynchrony index calculated from the difference between the frame number showing the maximum systolic movement in the septum and that showing the maximum systolic movement in the lateral wall [126].…”

Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 99%

“…Tsurugaya et al could classify patients into responders and non-responders to biventricular pacing on the basis of the improvement in left ventricular synchrony assessed by gated SPECT studies performed before and shortly after the onset of cardiac resynchronisation therapy [126]. To this end they used a simplified approach based on an asynchrony index calculated from the difference between the frame number showing the maximum systolic movement in the septum and that showing the maximum systolic movement in the lateral wall [126]. According to their results, the asynchrony index significantly improved after resynchronisation therapy in the responders, but not in the non-responders [126].…”

Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 99%

“…To this end they used a simplified approach based on an asynchrony index calculated from the difference between the frame number showing the maximum systolic movement in the septum and that showing the maximum systolic movement in the lateral wall [126]. According to their results, the asynchrony index significantly improved after resynchronisation therapy in the responders, but not in the non-responders [126]. These two reports indicate that perfusion gated SPECT can be used in these patients with the same effectiveness as ERNA, and is therefore a reasonable alternative to gated blood pool SPECT.…”

Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 99%

See 1 more Smart Citation

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Background Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. Discussion This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. Aim Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.

show abstract

“…Tsurugaya and colleagues (10) showed significant improvement in LV dyssynchrony in responders. After a follow-up of 18 ± 6 months, patients were classified as responders or nonresponders according to their clinical status and echocardiographic parameters.…”

Section: Discussionmentioning

confidence: 97%

LV dyssynchrony assessed with phase analysis on gated myocardial perfusion spect can predict response to crt in patients with end-stage heart failure

et al. 2014

View full text Add to dashboard Cite

Background:Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS).Objectives:The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder.Patients and Methods:Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation.Results:Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position.Conclusions:GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.

show abstract

Usefulness of quantitative gated single-Photon emission computed tomography to evaluate ventricular synchrony in patients receiving biventricular pacing

Cited by 7 publications

References 8 publications

Can LV Dyssynchrony as Assessed with Phase Analysis on Gated Myocardial Perfusion SPECT Predict Response to CRT?

Can LV Dyssynchrony as Assessed with Phase Analysis on Gated Myocardial Perfusion SPECT Predict Response to CRT?

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

LV dyssynchrony assessed with phase analysis on gated myocardial perfusion spect can predict response to crt in patients with end-stage heart failure

Contact Info

Product

Resources

About