Abstract
Background
Single-photon emission computed-tomography (SPECT) allows the quantification of LV eccentricity index (EI), a measure of cardiac remodeling. We sought to evaluate the feasibility of EI measurement with SPECT myocardial perfusion imaging and its interactions with relevant LV functional and structural parameters.
Methods and results
Four-hundred and fifty-six patients underwent myocardial perfusion imaging on a Cadmium-Zinc-Telluride (CZT) camera. The summed rest, stress, and difference scores were calculated. From rest images, the LV end-diastolic (EDV) and end-systolic volumes, ejection fraction (EF), and peak filling rate (PFR) were calculated. In every patient, the EI, ranging from 0 (sphere) to 1 (line), was computed using a dedicated software (QGS/QPS; Cedars-Sinai Medical Center). Three-hundred and thirty-eight/456 (74%) patients showed a normal EF (>50%), while 26% had LV systolic dysfunction. The EI was computed from CZT images with excellent reproducibility (interclass correlation coefficient: 0.99, 95% CI 0.98-0.99). More impaired EI values correlated with the presence of a more abnormal LV perfusion (P < .001), function (EF and PFR, P < .001), and structure (EDV, P < .001). On multivariate analysis, higher EDV (P < .001) and depressed EF (P = .014) values were independent predictors of abnormal EI.
Conclusions
The evaluation of LV eccentricity is feasible on gated CZT images. Abnormal EI associates with significant cardiac structural and functional abnormalities.
Similar content being viewed by others
Abbreviations
- CZT:
-
Cadmium-Zinc-Telluride
- SPECT:
-
Single-photon emission computed-tomography
- EI:
-
Eccentricity index
- MPI:
-
Myocardial perfusion imaging
- PFR:
-
Peak filling rate
- EF:
-
Ejection fraction
References
Burchfield JS, Xie M, Hill JA. Pathological ventricular remodeling: Mechanisms: Part 1 of 2. Circulation 2013;128:388–400.
Sutton MG, Sharpe N. Left ventricular remodeling after myocardial infarction: Pathophysiology and therapy. Circulation 2000;101:2981–8.
Kamperidis V, Delgado V, van Mieghem NM, Kappetein AP, Leon MB, Bax JJ. Diagnosis and management of aortic valve stenosis in patients with heart failure. Eur J Heart Fail 2016;18:469–81.
Drazner MH. The progression of hypertensive heart disease. Circulation 2011;123:327–34.
Gaasch WH, Zile MR. Left ventricular structural remodeling in health and disease: With special emphasis on volume, mass, and geometry. J Am Coll Cardiol 2011;58:1733–40.
Kono T, Sabbah HN, Rosman H, Alam M, Jafri S, Goldstein S. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol 1992;20:1594–8.
Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N. Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-New Zealand Heart Failure Research Collaborative Group. J Am Coll Cardiol 1997;29:1060–6.
Hayashi M, Tsutamoto T, Wada A, et al. Immediate administration of mineralocorticoid receptor antagonist spironolactone prevents post-infarct left ventricular remodeling associated with suppression of a marker of myocardial collagen synthesis in patients with first anterior acute myocardial infarction. Circulation 2003;107:2559–65.
Ambale-Venkatesh B, Yoneyama K, Sharma RK, Ohyama Y, Wu CO, Burke GL, et al. Left ventricular shape predicts different types of cardiovascular events in the general population. Heart 2016. doi:10.1136/heartjnl-2016-310052.
Levine YC, Matos J, Rosenberg MA, Manning WJ, Josephson ME, Buxton AE. Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy. Heart Rhythm 2016;13:490–7.
Aro AL, Reinier K, Phan D, Teodorescu C, Uy-Evanado A, Nichols GA, et al. Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction. Europace 2016. doi:10.1093/europace/euw126.
Phan D, Aro AL, Reinier K, Teodorescu C, Uy-Evanado A, Gunson K, et al. Left ventricular geometry and risk of sudden cardiac arrest in patients with severely reduced ejection fraction. J Am Heart Assoc 2016;5:e003715. doi:10.1161/JAHA.116.003715.
Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jarritt PH, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: The ROBUST study. Eur J Nucl Med Mol Imaging 2002;29:1608–16.
Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study. J Nucl Cardiol 2016. doi:10.1007/s12350-015-0360-8.
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.
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.
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.
Römer W, Reichel N, Vija HA, Nickel I, Hornegger J, Bautz W, Kuwert T. Isotropic reconstruction of SPECT data using OSEM3D: Correlation with CT. Acad Radiol 2006;13:496–502.
Gimelli A, Liga R, Giorgetti A, Kusch A, Pasanisi EM, Marzullo P. Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging. Eur J Nucl Med Mol Imaging 2015;42:994–1003.
Gimelli A, Liga R, Pasanisi EM, Casagranda M, Marzullo P. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J Nucl Cardiol 2016. doi:10.1007/s12350-016-0456-9.
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.
Xie M, Burchfield JS, Hill JA. Pathological ventricular remodeling: Therapies: Part 2 of 2. Circulation 2013;128:1021–30.
Berenji K, Drazner MH, Rothermel BA, Hill JA. Does load-induced ventricular hypertrophy progress to systolic heart failure? Am J Physiol Heart Circ Physiol 2005;289:H8–16.
Gimelli A, Liga R, Coceani M, Quaranta A, Emdin M, Marzullo P. Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: Impact on the accuracy in detecting coronary stenosis. Eur J Nucl Med Mol Imaging 2015;42:1903–11.
Hyun IY, Kwan J, Park KS, Lee WH. Reproducibility of Tl-201 and Tc-99m sestamibi gated myocardial perfusion SPECT measurement of myocardial function. J Nucl Cardiol 2001;8:182–7.
Aquaro GD, Camastra G, Monti L, Lombardi M, Pepe A, Castelletti S, et al. Reference values of cardiac volumes, dimensions, and new functional parameters by MR: A multicenter, multivendor study. J Magn Reson Imaging 2016. doi:10.1002/jmri.25450.
Krittayaphong R, Boonyasirinant T, Saiviroonporn P, Thanapiboonpol P, Nakyen S, Udompunturak S. Correlation between NT-pro BNP levels and left ventricular wall stress, sphericity index and extent of myocardial damage: A magnetic resonance imaging study. J Card Fail 2008;14:687–94.
Yun KL, Niczyporuk MA, Sarris GE, Fann JI, Miller DC. Importance of mitral subvalvular apparatus in terms of cardiac energetics and systolic mechanics in the ejecting canine heart. J Clin Invest 1991;87:247–54.
Genovesi D, Giorgetti A, Gimelli A, Kusch A, D’Aragona Tagliavia I, Casagranda M, et al. Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: Results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study. Eur J Nucl Med Mol Imaging 2011;38:1890–8.
Muraru D, Badano LP, Peluso D, Dal Bianco L, Casablanca S, Kocabay G, et al. Comprehensive analysis of left ventricular geometry and function by three-dimensional echocardiography in healthy adults. J Am Soc Echocardiogr 2013;26:618–28.
Disclosure
Drs Gimelli, Liga, Clemente, Marras, Kusch, and Marzullo, have no conflict of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Nagara Tamaki, MD.
Alessia Gimelli and Riccardo Liga—Shared first co-authorship.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Gimelli, A., Liga, R., Clemente, A. et al. Left ventricular eccentricity index measured with SPECT myocardial perfusion imaging: An additional parameter of adverse cardiac remodeling. J. Nucl. Cardiol. 27, 71–79 (2020). https://doi.org/10.1007/s12350-017-0777-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12350-017-0777-3