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Impact of scar on SPECT assay of left ventricular contraction dyssynchrony

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Many patients presently receiving cardiac resynchronization therapy (CRT) do not respond. A disproportionate number of nonresponders have ischemic cardiomyopathy, with significant left ventricular (LV) scar burden. Current selection criteria, such as electrocardiography or echocardiography, may not reliably portray the magnitude of CRT-remediable LV contraction dyssynchrony. Although phase analysis of gated single photon emission computed tomography (SPECT) image data is increasingly appreciated as a tool for quantifying dyssynchrony, its use in the setting of scar has not been adequately evaluated.

Methods

Consecutive patients with ischemic (ICM, n = 50) or nonischemic (NICM, n = 39) cardiomyopathy underwent SPECT imaging prior to receiving CRT. In each patient, phase analysis of the raw images was performed to yield a phase standard deviation (PSD), an index which varies directly with the magnitude of dyssynchrony. ICM patient image data were also reanalyzed after scarred segments were stripped away.

Results

Raw image analysis demonstrated that PSD was significantly larger among ICM (57 ± 17°) than NICM (35 ± 13°, p < 0.001) patients. Among ICM patients, PSD after stripping of scarred segments was significantly decreased (40 ± 13°, p < 0.001). Signals emanating from scarred segments were of low amplitude and presented a random pattern, suggestive of noise rather than indicating contraction.

Conclusion

PSD values may be spuriously increased by scar. These findings may be important when using SPECT in selecting ischemic cardiomyopathy patients for CRT.

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Abbreviations

SPECT:

Gated single photon emission computed tomography

ICM:

Ischemic cardiomyopathy

NICM:

Nonischemic cardiomyopathy

CRT:

Cardiac resynchronization therapy

LV:

Left ventricular

PSD:

Phase standard deviation

CMR:

Cardiac magnetic resonance imaging

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Authors and Affiliations

  1. Heart, Lung, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Daniel R. Ludwig, Mati Friehling, Erik B. Schelbert & David Schwartzman

  2. UPMC Presbyterian, B535, Pittsburgh, PA, 15213-2582, USA

    David Schwartzman

Authors
  1. Daniel R. Ludwig
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  2. Mati Friehling
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  3. Erik B. Schelbert
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  4. David Schwartzman
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Correspondence to David Schwartzman.

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Ludwig, D.R., Friehling, M., Schelbert, E.B. et al. Impact of scar on SPECT assay of left ventricular contraction dyssynchrony. Eur J Nucl Med Mol Imaging 41, 529–535 (2014). https://doi.org/10.1007/s00259-013-2608-3

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  • DOI: https://doi.org/10.1007/s00259-013-2608-3

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