Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Schmieder RE. End organ damage in hypertension. Dtsch Arztebl Int. 2010;107(49):866–73.

    PubMed  PubMed Central  Google Scholar 

  2. Hashimoto J. Central hemodynamics and target organ damage in hypertension. Tohoku J Exp Med. 2014;233(1):1–8.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  13. Daya HA, Malhotra S, Soman P. Radionuclide assessment of left ventricular dyssynchrony. Cardiol Clin. 2016;34:101–18.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, Clinical Development Research Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran

    Maryam Alvandi, Zahra Shaghaghi & Vahid Aryafar

  2. Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

    Farnaz Fariba

  3. Department of Community Medicine, Education Development Office, Hamadan University of Medical Sciences, Hamadan, Iran

    Zahra Sanaei

Authors
  1. Maryam Alvandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zahra Shaghaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vahid Aryafar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Farnaz Fariba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zahra Sanaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maryam Alvandi.

Ethics declarations

Conflict of interest

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alvandi, M., Shaghaghi, Z., Aryafar, V. et al. The evaluation of left ventricular dyssynchrony in hypertensive patients with a preserved systolic function undergoing gated SPECT myocardial perfusion imaging. Ann Nucl Med 33, 899–906 (2019). https://doi.org/10.1007/s12149-019-01402-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-019-01402-4

Keywords

Search

Navigation