Skip to main content

Advertisement

SpringerLink
Log in

Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera.

Methods

Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth.

Results

415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction.

Conclusions

LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

Abbreviations

CZT:

Cadmium-zinc-telluride

LVD:

Left ventricular dyssynchrony

EDV:

End-diastolic volume

ESV:

End-systolic volume

SD:

Standard deviation

TTP:

Time-to-peak contraction

References

  1. Sharma RK, Volpe G, Rosen BD, Ambale‐Venkatesh B, Donekal S, Fernandes V, et al. Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men: The multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2014. doi:10.1161/JAHA.114.000975.

    Google Scholar 

  2. AlJaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, et al. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010;17:398-404.

    Article  PubMed  Google Scholar 

  3. Morris DA, Vaz Perez A, Blaschke F, Eichstädt H, Ozcelik C, Haverkamp W. Myocardial systolic and diastolic consequences of left ventricular mechanical dyssynchrony in heart failure with normal left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2012;13:556-67.

    Article  PubMed  Google Scholar 

  4. AlJaroudi W, Koneru J, Iqbal F, Aggarwal H, Heo J, Iskandrian AE. Left ventricular mechanical dyssynchrony by phase analysis of gated single photon emission computed tomography in end-stage renal disease. Am J Cardiol 2010;106:1042-7.

    Article  PubMed  Google Scholar 

  5. Brandão SCS, Nishioka SAD, Giorgi MCP, Chen J, Abe R, Filho MM, et al. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: Changes in left ventricular uptake, dyssynchrony, and function. Eur J Nucl Med Mol Imaging 2009;36:986-96.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Singh H, Patel CD, Sharma P, Naik N, Singh S, Narang R. Does perfusion pattern influence stress-induced changes in left ventricular mechanical dyssynchrony on thallium-201-gated SPECT myocardial perfusion imaging? J Nucl Cardiol 2015;22:36-43.

    Article  PubMed  Google Scholar 

  7. Huang WS, Huang CH, Lee CL, Chen CP, Hung GU, Chen J. Relation of early post-stress left ventricular dyssynchrony and the extent of angiographic coronary artery disease. J Nucl Cardiol 2014;21:1048-56.

    Article  PubMed  Google Scholar 

  8. Gimelli A, Liga R, Genovesi D, Giorgetti A, Kusch A, Marzullo P. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: A cardiac CZT study. Eur J Nucl Med Mol Imaging 2014;41:946-55.

    Article  PubMed  Google Scholar 

  9. Gimelli A, Bottai M, Giorgetti A, Genovesi D, Kusch A, Ripoli A, et al. Comparison between ultrafast and standard single-photon emission CT in patients with coronary artery disease: A pilot study. Circ Cardiovasc Imaging 2011;4:51-8.

    Article  PubMed  Google Scholar 

  10. Giorgetti A, Masci PG, Marras G, Rustamova YK, Gimelli A, Genovesi D, et al. Gated SPECT evaluation of left ventricular function using a CZT camera and a fast low-dose clinical protocol: Comparison to cardiac magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2013;40:1869-75.

    Article  PubMed  Google Scholar 

  11. Pazhenkottil AP, Buechel RR, Herzog BA, Nkoulou RN, Valenta I, Fehlmann U, et al. Ultrafast assessment of left ventricular dyssynchrony from nuclear myocardial perfusion imaging on a new high-speed gamma camera. Eur J Nucl Med Mol Imaging 2010;37:2086-92.

    Article  PubMed  Google Scholar 

  12. Gimelli A, Liga R, Pasanisi EM, Casagranda M, Coceani M, Marzullo P. Influence of cardiac stress protocol on myocardial perfusion imaging accuracy: The role of exercise level on the evaluation of ischemic burden. J Nucl Cardiol 2015. doi:10.1007/s12350-015-0101-z.

    Google Scholar 

  13. Gimelli A, Liga R, Bottai M, Pasanisi EM, Giorgetti A, Fucci S, et al. Diastolic dysfunction assessed by ultra-fast cadmium-zinc-telluride cardiac imaging: Impact on the evaluation of ischaemia. Eur Heart J Cardiovasc Imaging 2015;16:68-73.

    Article  PubMed  Google Scholar 

  14. Gimelli A, Liga R, Pasanisi EM, Giorgetti A, Marras G, Favilli B, et al. Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: Comparison with Doppler echocardiography. Eur Heart J Cardiovasc Imaging 2014;15:972-9.

    Article  PubMed  Google Scholar 

  15. AlJaroudi W, Jaber WA, Grimm RA, Marwick T, Cerqueira MD. Alternative methods for the assessment of mechanical dyssynchrony using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. Int J Cardiovasc Imaging 2012;28:1385-94.

    Article  PubMed  Google Scholar 

  16. van der Veen BJ, Al Younis I, Ajmone-Marsan N, Westenberg JJ, Bax JJ, Stokkel MP, et al. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: A feasibility study. Eur J Nucl Med Mol Imaging 2012;39:421-9.

    Article  PubMed  Google Scholar 

  17. Boogers MJ, Chen J, van Bommel RJ, Borleffs CJ, Dibbets-Schneider P, van der Hiel B, et al. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2011;38:230-8.

    Article  PubMed  Google Scholar 

  18. Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-95.

    Article  PubMed  Google Scholar 

  19. Liga R, Marini C, Coceani M, Filidei E, Schlueter M, Bianchi M, et al. Structural abnormalities of the coronary arterial wall—in addition to luminal narrowing—affect myocardial blood flow reserve. J Nucl Med 2011;52:1704-12.

    Article  PubMed  Google Scholar 

  20. Clements IP. Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction. Eur J Heart Fail 2005;7:490-7.

    Article  PubMed  Google Scholar 

  21. Denney TS Jr, Nagaraj HM, Lloyd SG, Aban I, Corros C, Seghatol-Eslami F, et al. Effect of primary mitral regurgitation on left ventricular synchrony. Am J Cardiol 2007;100:707-11.

    Article  PubMed  Google Scholar 

Download references

Disclosure

Alessia Gimelli, Riccardo Liga, Assuero Giorgetti, Brunella Favilli, Emilio Maria Pasanisi, and Paolo Marzullo have no conflicts of interest to disclose.

Author information

Author notes

    Authors and Affiliations

    1. Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy

      Alessia Gimelli MD, Assuero Giorgetti MD, Brunella Favilli RT, Emilio Maria Pasanisi MD & Paolo Marzullo MD

    2. University Hospital of Pisa, Pisa, Italy

      Riccardo Liga MD

    3. CNR, Institute of Clinical Physiology, Pisa, Italy

      Paolo Marzullo MD

    Authors
    1. Alessia Gimelli MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Riccardo Liga MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Assuero Giorgetti MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Brunella Favilli RT
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Emilio Maria Pasanisi MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Paolo Marzullo MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Riccardo Liga MD.

    Additional information

    See related editorial, doi:10.1007/s12350-015-0276-3.

    Alessia Gimelli and Riccardo Liga have contributed equally to this study.

    Electronic Supplementary Material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (DOC 35 kb)

    Supplementary material 2 (DOC 35 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Gimelli, A., Liga, R., Giorgetti, A. et al. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J. Nucl. Cardiol. 23, 728–736 (2016). https://doi.org/10.1007/s12350-015-0247-8

    Download citation

    • Received:

    • Revised:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s12350-015-0247-8

    Keywords

    Search

    Navigation