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Cardiac function changes with switching from the supine to prone position: Analysis by quantitative semiconductor gated single-photon emission computed tomography

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Prone positioning is required in certain operations such as spinal surgery. Changes in cardiac function in the prone position have been studied with various methodologies. Few studies have investigated changes in left ventricular diastolic function and rhythm in subjects turned prone.

Methods and Results

Cardiac function was evaluated in the supine and prone positions in 90 patients without atrial fibrillation who underwent 99mTc-tetrofosmin quantitative gated single-photon emission computed tomography. Three groups of 30 patients each were classified as “no history of myocardial ischemia or cardiomyopathy” (Group A), “history of myocardial infarction” (Group B), and “ischemic heart disease without myocardial infarction history” (Group C). Upon assuming the prone position, the cardiac index and any dyssynchrony worsened in all groups. Ejection fraction changes occurred only in Group B, and diastolic function changes occurred in Groups B and C, but not in Group A. The changes caused by prone positioning were more severe in the patients with poor cardiac function.

Conclusions

Prone positioning induces significant changes in systolic and diastolic function, as well as dyssynchrony. The negative effects of prone positioning are more severe in patients with poor baseline cardiac function.

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References

  1. Pearce DJ. The role of posture in laminectomy. Proc R Soc Med 1957;50:109-12.

    CAS  PubMed Central  PubMed  Google Scholar 

  2. Hirakawa M. Hemodynamic changes in prone position. Masui 1988;37:1314-20.

    CAS  PubMed  Google Scholar 

  3. Yokoyama M, Ueda W, Hirakawa M, Yamamoto H. Hemodynamic effect of the prone position during anesthesia. Acta Anaesthesiol Scand 1991;35:741-4.

    Article  CAS  PubMed  Google Scholar 

  4. Soliman DE, Maslow AD, Bokesch OM, Stratford M, Karlin L, Rhodes J, et al. Reports of investigation transoesophageal echocardiography during scoliosis repair: Comparison with CVP monitoring. Can J Anaesth 1998;45:925-32.

    Article  CAS  PubMed  Google Scholar 

  5. Berman D, Germano G, Lewin H, Kang X, Kavanagh PB, Tapnio P, et al. Comparison of post-stress ejection fraction and relative left ventricular volumes by automatic analysis of gated myocardial perfusion single-photon emission computed tomography acquired in the supine and prone positions. J Nucl Cardiol 1998;5:40-7.

    Article  CAS  PubMed  Google Scholar 

  6. Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: Multicenter comparison with standard dual detector cameras. J Nucl Cardiol 2009;16:927-34.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ioannidis JPA, Trikalinos TA, Danias PG. Electrocardiogram-gated single-photon emission computed tomography versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction: A meta-analysis. JACC 2002;39:2059-68.

    Article  PubMed  Google Scholar 

  8. Nakae I, Matsuo S, Koh T, Mitsunami K, Horie M. Left ventricular systolic/diastolic function evaluated by quantitative ECG-gated SPECT: Comparison with echocardiography and plasma BNP analysis. Ann Nucl Med 2005;19:447-54.

    Article  CAS  PubMed  Google Scholar 

  9. Chen J, Garcia EV, Lerakis S, Henneman MM, Bax JJ, Trimble MA, et al. Left ventricular mechanical dyssynchrony as assessed by phase analysis of ECG-gated SPECT myocardial perfusion imaging. Echocardiography 2008;25:1186-94.

    Article  PubMed  Google Scholar 

  10. Yap K, Campbell P, Cherk M, McGrath C, Kalff V. Effect of prone versus supine positioning on left ventricular ejection fraction (LVEF) and heart rate using ECG gated Tl-201 myocardial perfusion scans and gated cardiac blood pool scans. J Med Imaging Radiat Oncol 2012;56:525-31.

    Article  Google Scholar 

  11. Udelson JE. Heart failure with preserved ejection fraction. Circulation 2011;124:e540-3.

    Article  PubMed  Google Scholar 

  12. McAlister FA, Ezekowitz J, Hooton N, Vandermeer B, Spooner C, Dryden DM, et al. Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction. A systematic review. J Am Med Assoc 2007;297:2502-14.

    Article  CAS  Google Scholar 

  13. Levine MG, Ahlberg AW, Mann A, White MP, McGill CC, Mendes de Leon C, et al. Comparison of exercise, dipyridamole, adenosine, and dobutamine stress with the use of Tc-99m tetrofosmin tomographic imaging. J Nucl Cardiol 1999;6:389-96.

    Article  CAS  PubMed  Google Scholar 

  14. Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: Multicenter comparison with standard dual detector cameras. J Nucl Cardiol 2009;16:927-34.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Paeng JC, Lee DS, Cheon GJ, Lee MM, Chung JK, Lee MC. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated 99mTc-sestamibi myocardial SPECT. J Nucl Med 2001;42:695-700.

    CAS  PubMed  Google Scholar 

  16. 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 

  17. Pump B, Talleruphuus U, Christensen NJ, Warberg J, Norsk P. Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. Am J Physiol Regul Integr Comp Physiol 2002;283:R174-80.

    Article  CAS  PubMed  Google Scholar 

  18. Schaefer WM, Lipke CSA, Kühl HP, Koch KC, Kaiser HJ, Reinartz P, et al. Prone versus supine patient positioning during gated 99mTc-sestamibi SPECT: Effect on left ventricular volumes, ejection fraction, and heart rate. J Nucl Med 2004;45:2016-20.

    PubMed  Google Scholar 

  19. Chiumello D, Cressoni M, Racagni M, Landi L, Bassi GL, Polli F, et al. Effects of thoraco-pelvic supports during prone position in patients with acute lung injury/acute respiratory distress syndrome: A physiological study. Crit Care 2006;10:R87.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kubitz JC, Annecke T, Kemming GI, Forkl S, Kronas N, Goetz AE, et al. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg 2006;30:90-5.

    Article  PubMed  Google Scholar 

  21. Gilbert JC, Grantz S. Determinants of left ventricular filling and of the diastolic pressure-volume relation. Circ Res 1989;64:827-52.

    Article  CAS  PubMed  Google Scholar 

  22. Caracciolo G, Goliasch G, Amaki M, Bansal M, Nakabo A, Abe H, et al. Myocardial stretch in early systole is a key determinant of the synchrony of left ventricular mechanical activity in vivo. Circ J 2013;77:2526-34.

    Article  PubMed  Google Scholar 

  23. Kato T, Ohte N, Wakami K, Goto T, Fukuta H, Narita H, et al. Myocardial fiber shortening in the circumferential direction produces left ventricular wall thickening during contraction. Tohoku J Exp Med 2010;222:175-81.

    Article  PubMed  Google Scholar 

  24. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.

    Article  PubMed  Google Scholar 

  25. Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. Sleep 2001;24:538-44.

    CAS  PubMed  Google Scholar 

  26. Tiotiu A, Mairesse O, Hoffmann G, Todea D, Noseda A. Body position and breathing abnormalities during sleep: A systematic study. Pneumologia 2011;60:216-21.

    PubMed  Google Scholar 

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Acknowledgments

We thank Mr. Masami Hasegawa and Mr. Shigenori Uchida for their excellent technical assistance.

Disclosures

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan

    Masato Shimizu MD, Hiroyuki Fujii MD, Noriyoshi Yamawake MD & Mitsuhiro Nishizaki MD

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  1. Masato Shimizu MD
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  2. Hiroyuki Fujii MD
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  3. Noriyoshi Yamawake MD
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  4. Mitsuhiro Nishizaki MD
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Correspondence to Masato Shimizu MD.

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Shimizu, M., Fujii, H., Yamawake, N. et al. Cardiac function changes with switching from the supine to prone position: Analysis by quantitative semiconductor gated single-photon emission computed tomography. J. Nucl. Cardiol. 22, 301–307 (2015). https://doi.org/10.1007/s12350-014-0058-3

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  • DOI: https://doi.org/10.1007/s12350-014-0058-3

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