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Are SPECT MPI measures of dyssynchrony dyssynchronous?

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Abstract

Background

Assessment of left ventricular mechanical dyssynchrony (LVMD) from gated SPECT myocardial perfusion imaging (MPI) aims to aid selection of patients for cardiac resynchronization therapy (CRT), using either the standard deviation of left ventricular phase (PSD) ≥ 43° or phase histogram bandwidth (HBW) of > 38° and > 30.6° in males and females, respectively. We observed dyssynchrony parameters might be affected by test type and alignment.

Methods

We reviewed 242 patients who underwent gated SPECT MPI with use of the Emory Cardiac Toolbox comparing PSD and HBW at rest and stress for Pearson correlation, and substitutability with Bland–Altman analysis.

Results

There is statistically significant difference in the mean PSD and HBW during rest vs stress (33.4 ± 17.4° vs 20.7 ± 13.5° and 97.7 ± 59.6° vs 59.4 ± 45.4°, respectively, P < 0.001). Proper valve plane alignment rendered smaller values (i.e., less dyssynchrony) in both phase SD and HBW (16.8 ± 13.5) vs (22.2 ± 14.7) (P = 0.011), and (47.0 ± 38.2) vs (60.7 ± 48.0) (P = 0.023), respectively.

Conclusion

Proper alignment and test type, particularly low-dose rest vs high-dose stress, should be considered when assessing LVMD using SPECT MPI.

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Abbreviations

LVMD:

Left ventricular mechanical dyssynchrony

CRT:

Cardiac resynchronization therapy

HFpEF:

Heart failure with preserved ejection fraction

SPECT:

Single-photon emission computerized tomography

MPI:

Myocardial perfusion imaging

PSD:

Standard deviation of left ventricular phase

HBW:

Histogram bandwidth

ASNC:

American Society of Nuclear Cardiology

TID:

Transient ischemic dilation

LV:

Left ventricle

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Disclosure

Omaima Ali, Maithili Shenoy, Anas Alani, Maath Alani, and Kim Williams declare that they have no conflict of interest.

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Correspondence to Omaima Ali MD.

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Ali, O., Shenoy, M., Alani, A. et al. Are SPECT MPI measures of dyssynchrony dyssynchronous?. J. Nucl. Cardiol. (2020). https://doi.org/10.1007/s12350-019-02024-z

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Keywords

  • SPECT
  • MPI
  • dyssynchrony
  • image interpretation