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Annals of Nuclear Medicine

, Volume 33, Issue 12, pp 899–906 | Cite as

The evaluation of left ventricular dyssynchrony in hypertensive patients with a preserved systolic function undergoing gated SPECT myocardial perfusion imaging

  • Maryam AlvandiEmail author
  • Zahra Shaghaghi
  • Vahid Aryafar
  • Farnaz Fariba
  • Zahra Sanaei
Original Article

Abstract

Background

Hypertension as a known risk factor for cardiovascular diseases can result in left ventricular dyssynchrony (LVD) leading to uncoordinated contraction. The aim of our study was to evaluate whether systolic mechanical dyssynchrony measured by phase analysis of gated single-photon emission computed tomography (SPECT) imaging occurs in hypertensive patients with a low risk for coronary artery disease and a normal ejection fraction and its possible relationships with severity of hypertension and the influence of antihypertensive treatments.

Methods

A total of 466 patients (328 females and 138 males, with a mean age of 59.62 ± 10.27 years) who had a low risk factor for coronary artery disease, a normal perfusion study and, a normal ejection fraction were included of which 408 was hypertensive and 58 normotensive. Phase analysis parameters (derived using QGS software) were compared in patients with and without hypertension. Using different statistical methods, relationship between derived phase analysis indices (PSD, PHB) for LVD and amount of blood pressure and antihypertensive drugs consumption were evaluated.

Results

The prevalence of LVD in patients with hypertension was 63.2% (n = 258), while it was 6.9% in the normotensive group. The mean values of PSD and PHB were higher in hypertensive patients than normotensive ones (12.55 vs. 5.8 and 39.24 vs. 21.12), respectively, so that, statistically significant differences were found between the patients with and without hypertension (p < 0.001). Furthermore, there was a clear relationship between the severity of hypertension and the degree of LVD: by increasing 1 mmHg in systolic and diastolic blood pressure, PSD and PHB increase by (0.034, 0.108 and 0.035, 0.0311), respectively. The statistical results showed that the frequency of LVD in controlled hypertensive patients taking antihypertensive drugs was 55.2%, which significantly lower compared to the patient suffering from hypertension without taking any hypertensive drug (81.35%, p < 0.001).

Conclusion

Our study findings are in favor of using phase analysis-gated SPECT imaging as a routine way for detection of LVD—known indicator of progression toward systolic dysfunction in the future—in hypertensive patients with a low risk for coronary artery diseases and a normal cardiac systolic function.

Keywords

Phase analysis LV dyssynchrony Gated SPECT MPI Hypertension 

Notes

Acknowledgements

We would like to thank the Clinical Research Development Unit of Farshchian Heart Center, Hamadan University of Medical Science for helpful support to our experiment. We are also immensely grateful to Afshin Rezapour for careful editing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest and no funding was received for this study.

References

  1. 1.
    Schmieder RE. End organ damage in hypertension. Dtsch Arztebl Int. 2010;107(49):866–73.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Hashimoto J. Central hemodynamics and target organ damage in hypertension. Tohoku J Exp Med. 2014;233(1):1–8.CrossRefGoogle Scholar
  3. 3.
    Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:2199–269.CrossRefGoogle Scholar
  4. 4.
    Ozdemir S, Kırılmaz B, Barutçu A, Tan YZ, Celik F, Akgoz S. The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT. Ann Nucl Med. 2015;29(3):240–7.CrossRefGoogle Scholar
  5. 5.
    Nagakura T, Takeuchi M, Yoshitani H, Nakai H, Nishikage T, Kokumai M, Otani S, Yoshiyama M, Yoshikawa J. Hypertrophic cardiomyopathy is associated with more severe left ventricular dyssynchrony than is hypertensive left ventricular hypertrophy. Echocardiography. 2007;24(7):677–84.CrossRefGoogle Scholar
  6. 6.
    Ternacle J, Bremont C, d’Humieres T, Faivre L, Doan HL, Gallet R, Oliver L, Dubois-Rand JL, Lim P. Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy. Arch Cardiovasc Dis. 2017;110:403–12.CrossRefGoogle Scholar
  7. 7.
    Wang L, Yang MF, Cai M, Zhao SH, He ZX, Wang YT. Prognostic significance of left ventricular dyssynchrony by phase analysis of gated SPECT in medically treated patients with dilated cardiomyopathy. Clin Nucl Med. 2013;38(7):510–5.CrossRefGoogle Scholar
  8. 8.
    Santos AB, Kraigher-Krainer E, Bello N, Claggett B, Zile MR, Pieske B, et al. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction. Eur Heart J. 2014;35(1):42–7.CrossRefGoogle Scholar
  9. 9.
    Liu S, Guan Z, Jin X, Meng P, Wang Y, Zheng X, et al. Left ventricular diastolic and systolic dyssynchrony and dysfunction in heart failure with preserved ejection fraction and a narrow QRS complex. Int J Med Sci. 2018;15(2):108–14.CrossRefGoogle Scholar
  10. 10.
    Henneman MM, Chen J, Dibbets-Schneider P, Stokkel MP, Bleeker GB, Ypenburg C, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med. 2007;48(7):1104–11.CrossRefGoogle Scholar
  11. 11.
    Ng AC, Da Tran T, Allman C, Vidaic J, Leung DY. Prognostic implications of left ventricular dyssynchrony early after non-ST elevation myocardial infarction without congestive heart failure. Eur Heart J. 2010;31(3):298–308.CrossRefGoogle Scholar
  12. 12.
    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;3(4):e000975.CrossRefGoogle Scholar
  13. 13.
    Daya HA, Malhotra S, Soman P. Radionuclide assessment of left ventricular dyssynchrony. Cardiol Clin. 2016;34:101–18.CrossRefGoogle Scholar
  14. 14.
    Zoroufian A, Razmi T, Savandroomi Z, Tokaldany ML, Sadeghian H, Sahebjam M, et al. Correlation between systolic deformation and dyssynchrony indices and the grade of left ventricular hypertrophy in hypertensive patients with a preserved systolic ejection fraction undergoing coronary angiography, based on tissue doppler imaging. J Ultrasound Med. 2014;33(1):119–28.CrossRefGoogle Scholar
  15. 15.
    Chen J, Garcia EV, Henneman MM, Bax JJ, Boogers MJ, Trimble MA, et al. Measuring left ventricular mechanical dyssynchrony from ECG-gated SPECT myocardial perfusion imaging. Minerva Cardioangiol. 2008;56(2):227–35.PubMedGoogle Scholar
  16. 16.
    Westenberg JJ, Lamb HJ, van der Geest RJ, Bleeker GB, Holman ER, Schalij MJ, et al. Assessment of left ventricular dyssynchrony in patients with conduction delay and idiopathic dilated cardiomyopathy: head-to-head comparison between tissue doppler imaging and velocity-encoded magnetic resonance imaging. J Am Coll Cardiol. 2006;47(10):2042–8.CrossRefGoogle Scholar
  17. 17.
    Rastgou F, Shojaeifard M, Amin A, Ghaedian T, Firoozabadi H, Malek H, et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: comparison between QGS and ECTb software packages. J Nucl Cardiol. 2014;21(6):1062–71.CrossRefGoogle Scholar
  18. 18.
    Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor4DM: the Michigan method for quantitative nuclear cardiology. J Nucl Cardiol. 2007;14(4):455–65.CrossRefGoogle Scholar
  19. 19.
    Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005;32(7):855–97.CrossRefGoogle Scholar
  20. 20.
    Ababneh AA, Sciacca RR, Kim B, Bergmann SR. Normal limits for left ventricular ejection fraction and volumes estimated with gated myocardial perfusion imaging in patients with normal exercise test results: influence of tracer, gender, and acquisition camera. J Nucl Cardiol. 2000;7(6):661–8.CrossRefGoogle Scholar
  21. 21.
    Okuda K, Nakajima K, Matsuo S, Kashiwaya S, Yoneyama H, Shibutani T, et al. Comparison of diagnostic performance of four software packages for phase dyssynchrony analysis in gated myocardial perfusion SPECT. EJNMMI Res. 2017;7:27.CrossRefGoogle Scholar
  22. 22.
    Chen J, Garcia EV, Bax JJ, Iskandrian AE, Borges-Neto S, Soman P. SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony. J Nucl Cardiol. 2011;18(4):685–94.CrossRefGoogle Scholar
  23. 23.
    Germano G, Kavanagh PB, Slomka PJ, Van Kriekinge SD, Pollard G, Berman DS. Quantitation in gated perfusion SPECT imaging: the Cedars-Sinai approach. J Nucl Cardiol. 2007;14(4):433–54.CrossRefGoogle Scholar
  24. 24.
    Misaka T, Hosono M, Kudo T, Ito T, Syomura T, Uemura M, et al. Influence of acquisition orbit on phase analysis of gated single photon emission computed tomography myocardial perfusion imaging for assessment of left ventricular mechanical dyssynchrony. Ann Nucl Med. 2017;31(3):235–44.CrossRefGoogle Scholar
  25. 25.
    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(1):36–43.CrossRefGoogle Scholar
  26. 26.
    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(11):2086–92.CrossRefGoogle Scholar
  27. 27.
    Alvandi M, Razavi-Ratki SK, Shaghaghi Z, Khosrowshahi AG, Rabiei MAS, Zebarjadi S. Prevalence of left ventricular dyssynchrony in individuals undergoing gated SPECT myocardial perfusion imaging using phase analysis. IHJ. 2019;20(3):66–74.Google Scholar
  28. 28.
    Tavares A, Peclat T, Lima RSL. Prevalence and predictors of left intraventricular dyssynchrony determined by phase analysis in patients undergoing gatedSPECT myocardial perfusion imaging. Int J Cardiovasc Imaging. 2016;32(5):845–52.CrossRefGoogle Scholar
  29. 29.
    Nucifora G, Bertini M, Marsan NA, Delgado V, Scholte AJ, Ng AC, et al. Impact of left ventricular dyssynchrony early on left ventricular function after first acute myocardial infarction. Am J Cardiol. 2010;105(3):306–11.CrossRefGoogle Scholar
  30. 30.
    Jiang Z, Zhou W. Left ventricular mechanical dyssynchrony for CAD diagnosis: does it have incremental clinical values? J Nucl Cardiol. 2018.  https://doi.org/10.1007/s12350-018-1440-3.CrossRefPubMedGoogle Scholar
  31. 31.
    Tanaka H, Chikamori T, Hida S, Igarashi Y, Shiba C, Usui Y, et al. Diagnostic value of vasodilator-induced left ventricular dyssynchrony as assessed by phase analysis to detect multivessel coronary artery disease. Ann Nucl Cardiol. 2015;1:6–17.CrossRefGoogle Scholar
  32. 32.
    Vancheri F, Vancheri S, Henein MY. Effect of age on left ventricular global dyssynchrony in asymptomatic individuals: a population study. Echocardiography. 2016;33(7):977–83.CrossRefGoogle Scholar
  33. 33.
    Bonow RO, Vitale DF, Bacharach SL, Maron BJ, Green MV. Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects. J Am Coll Cardiol. 1988;11(1):50–8.CrossRefGoogle Scholar
  34. 34.
    Furutani Y, Yano M, Yuki K, Yamada H, Yamagishi T, Ozaki M, et al. Age-related modification of regional left ventricular filling in normal subjects. Kaku Igaku. 1990;27(3):199–208.PubMedGoogle Scholar
  35. 35.
    Santos AB, Kraigher-Krainer E, Bello N, Claggett B, Zile MR, Pieske B, et al. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction. Eur Heart J. 2014;35(1):42–7.CrossRefGoogle Scholar
  36. 36.
    Peix A, Padrón K, Cabrera LO, Pardo L, Sánchez J. Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries. J Nucl Cardiol. 2019.  https://doi.org/10.1007/s12350-019-01804-x.CrossRefPubMedGoogle Scholar
  37. 37.
    Mukherjee A, Singh H, Patel C, Sharma G, Roy A, Naik N. Normal values of cardiac mechanical synchrony parameters using gated myocardial perfusion single-photon emission computed tomography: impact of population and study protocol. Indian J Nucl Med. 2016;31(4):255–9.CrossRefGoogle Scholar
  38. 38.
    Kwon BJ, Jang SW, Choi KY, Kim DB, Cho EJ, Ihm SH, et al. Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients. Hypertens Res. 2012;35(6):661–6.CrossRefGoogle Scholar
  39. 39.
    Bader H, Garrigue S, Lafitte S, Reuter S, Jaïs P, Haïssaguerre M, et al. Intra-left ventricular electromechanical asynchrony: a new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol. 2004;43(2):248–56.CrossRefGoogle Scholar
  40. 40.
    Seo HS, Cho YH, Choi JH, Suh J, Lee NH, Lim OK. The association of left ventricular hypertrophy with intraventricular dyssynchrony at rest and during exercise in hypertensive patients. J Cardiovasc Ultrasound. 2012;20(4):174–80.CrossRefGoogle Scholar
  41. 41.
    Kaya MG, Sarli B, Akpek M, Kaya EG, Yarlioglues M, Topsakal R, et al. Evaluation of beta-blockers on left ventricular dyssynchrony and reverse remodeling in idiopathic dilated cardiomyopathy: a randomized trial of carvedilol and metoprolol. Cardiol J. 2014;21(4):434–41.CrossRefGoogle Scholar
  42. 42.
    Miyachi H, Yamamoto A, Otsuka T, Yoshikawa M, Kodani E, Endoh Y, et al. Relationship between left ventricular dyssynchrony and systolic dysfunction is independent of impaired left ventricular myocardial perfusion in heart failure: assessment with 99mTc-sestamibi gated myocardial scintigraphy. Int J Cardiol. 2013;167(3):930–5.CrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine and Molecular Imaging, Clinical Development Research Unit of Farshchian Heart CenterHamadan University of Medical SciencesHamadanIran
  2. 2.Department of Cardiology, School of MedicineHamadan University of Medical SciencesHamadanIran
  3. 3.Department of Community MedicineEducation Development Office, Hamadan University of Medical SciencesHamadanIran

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