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SPECT blood pool phase analysis can accurately and reproducibly quantify mechanical dyssynchrony

Journal of Nuclear Cardiology volume 17, pages 803–810 (2010)Cite this article

Abstract

Objectives

Phase analysis of SPECT blood pool imaging has the potential to assess mechanical dyssynchrony (MD). However, wall motion of the left ventricle (LV) from SPECT images can be based on either time-activity or time-distance curves. In this paper, these two techniques were compared using receiver-operator characteristics (ROC) analysis at detecting MD patients from a population of normal subjects.

Methods

SPECT phase analysis was performed on 48 normal subjects (LVEF > 55%, normal wall motion, QRS < 120 ms), and 55 MD patients (LVEF < 35%, QRS > 120 ms). ROC analysis was individually performed on each of three phase parameters (phase standard deviation, synchrony, and entropy) for each LV wall motion technique. ROC area differences were assessed using the Student t-test. Intra- and inter-observer reproducibilities were investigated using regression analysis.

Results

Time-activity-based phase analysis produced excellent ROC areas of .93 or better for all three phase parameters. The time-distance techniques produced significantly (P < .05) lower ROC areas in the range of .53-.76. Time-activity-based phase analysis had excellent intra- and inter-observer reproducibility with correlation coefficients >.96, compared to values of ~.85 for the time-distance methods.

Conclusion

SPECT time-activity-based phase analysis had excellent sensitivity and specificity at detecting MD patients with very high intra- and inter-observer reproducibility.

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References

  1. Vardas PE, Auricchio A, Blanc JJ, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2007;28:2256-95.

    Article  PubMed  Google Scholar 

  2. Strickberger SA, Conti J, Daoud EG, et al. Patient selection for cardiac resynchronization therapy: From the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation 2005;111:2146-50.

    Article  PubMed  Google Scholar 

  3. Birnie DH, Tang AS. The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol 2006;21:20-6.

    Article  PubMed  Google Scholar 

  4. Botvinick EH, William OJ, Badhwar N. Imaging synchrony. J Nucl Cardiol 2009;16:846-8.

    Article  PubMed  Google Scholar 

  5. Penicka M, Bartunek J, De BB, et al. Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation 2004;109:978-83.

    Article  PubMed  Google Scholar 

  6. Yu CM, Zhang Q, Chan YS, et al. Tissue Doppler velocity is superior to displacement and strain mapping in predicting left ventricular reverse remodelling response after cardiac resynchronisation therapy. Heart 2006;92:1452-6.

    Article  PubMed  Google Scholar 

  7. Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2003;92:341-4.

    Article  PubMed  Google Scholar 

  8. Yu CM, Abraham WT, Bax J, et al. Predictors of response to cardiac resynchronization therapy (PROSPECT)—Study design. Am Heart J 2005;149:600-5.

    Article  PubMed  Google Scholar 

  9. Lardo AC, Abraham TP, Kass DA. Magnetic resonance imaging assessment of ventricular dyssynchrony: Current and emerging concepts. J Am Coll Cardiol 2005;46:2223-8.

    Article  PubMed  Google Scholar 

  10. White JA, Yee R, Yuan X, et al. Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony. J Am Coll Cardiol 2006;48:1953-60.

    Article  PubMed  Google Scholar 

  11. Chen J, Henneman MM, Trimble MA, et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2008;15:127-36.

    Article  PubMed  Google Scholar 

  12. Henneman MM, Chen J, Gibbets-Schneider P, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 2007;48:1104-11.

    Article  PubMed  Google Scholar 

  13. Botvinick EH. Scintigraphic blood pool and phase image analysis: The optimal tool for the evaluation of resynchronization therapy. J Nucl Cardiol 2003;10:424-8.

    Article  PubMed  Google Scholar 

  14. Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: A prognostic study with Fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 2002;40:2022-30.

    Article  PubMed  Google Scholar 

  15. Wassenaar R, O’Connor D, Dej B, Ruddy TD, Birnie D. Optimization and validation of radionuclide angiography phase analysis parameters for quantification of mechanical dyssynchrony. J Nucl Cardiol 2009;16:895-903.

    Article  PubMed  Google Scholar 

  16. Botvinick E, Dunn R, Frais M, et al. The phase image: Its relationship to patterns of contraction and conduction. Circulation 1982;65:551-60.

    CAS  PubMed  Google Scholar 

  17. Botvinick EH, Frais MA, Shosa DW, et al. An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis. Am J Cardiol 1982;50:289-98.

    CAS  Article  PubMed  Google Scholar 

  18. O’Connell JW, Schreck C, Moles M, et al. A unique method by which to quantitate synchrony with equilibrium radionuclide angiography. J Nucl Cardiol 2005;12:441-50.

    Article  PubMed  Google Scholar 

  19. Harel F, Finnerty V, Gregoire J, Thibault B, Khairy P. Comparison of left ventricular contraction homogeneity index using SPECT gated blood pool imaging and planar phase analysis. J Nucl Cardiol 2008;15:80-5.

    Article  PubMed  Google Scholar 

  20. Muramatsu T, Matsumoto K, Nishimura S. Efficacy of the phase images in Fourier analysis using gated cardiac POOL-SPECT for determining the indication for cardiac resynchronization therapy. Circ J 2005;69:1521-6.

    Article  PubMed  Google Scholar 

  21. Adachi I, Akagi H, Umeda T, et al. Gated blood pool SPECT improves reproducibility of right and left ventricular Fourier phase analysis in radionuclide angiography. Ann Nucl Med 2003;17:711-6.

    Article  PubMed  Google Scholar 

  22. Vilain D, Daou D, Casset-Senon D, Faraggi M, Le GD. Optimal 3-dimensional method for right and left ventricular Fourier phase analysis in electrocardiography-gated blood-pool SPECT. J Nucl Cardiol 2001;8:371-8.

    CAS  Article  PubMed  Google Scholar 

  23. Klein R, Lortie M, Adler A, Beanlands RS, deKemp RA. Fully automated software for polar-map registration and sampling from PET images. Nucl Sci Symp Med Imag Conf Record 2006;6:3185-8.

    Article  Google Scholar 

  24. Lortie M, Beanlands RS, Yoshinaga K, Klein R, DaSilva JN, deKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging 2007;34:1765-74.

    Article  PubMed  Google Scholar 

  25. Links JM, Douglass KH, Wagner HN Jr. Patterns of ventricular emptying by Fourier analysis of gated blood-pool studies. J Nucl Med 1980;21:978-82.

    CAS  PubMed  Google Scholar 

  26. Somsen GA, Verberne HJ, Burri H, Ratib O, Righetti A. Ventricular mechanical dyssynchrony and resynchronization therapy in heart failure: A new indication for Fourier analysis of gated blood-pool radionuclide ventriculography. Nucl Med Commun 2006;27:105-12.

    Article  PubMed  Google Scholar 

  27. Chen J, Garcia EV, Folks RD, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-95.

    Article  PubMed  Google Scholar 

  28. Ajmone MN, Henneman MM, Chen J, et al. Left ventricular dyssynchrony assessed by two three-dimensional imaging modalities: Phase analysis of gated myocardial perfusion SPECT and tri-plane tissue Doppler imaging. Eur J Nucl Med Mol Imaging 2008;35:166-73.

    Article  Google Scholar 

  29. Siegrist PT, Comte N, Holzmeister J, et al. Effects of AV delay programming on ventricular resynchronisation: Role of radionuclide ventriculography. Eur J Nucl Med Mol Imaging 2008;35:1516-22.

    Article  PubMed  Google Scholar 

  30. Harel F, Finnerty V, Ngo Q, Gregoire J, Khairy P, Thibault B. SPECT versus planar gated blood pool imaging for left ventricular evaluation. J Nucl Cardiol 2007;14:544-9.

    Article  PubMed  Google Scholar 

  31. Henneman MM, Bax J, Chen J, Garcia EV. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT preferably predict response to CRT? J Nucl Med 2008;49:686-a.

    Article  Google Scholar 

  32. Chung ES, Leon AR, Tavazzi L, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608-16.

    Article  PubMed  Google Scholar 

  33. Lalonde M, Birnie D, Ruddy T, Wassenaar R. Analysis of amplitude from SPECT phase analysis predicts CRT outcome in non-scar patients. Soc Nucl Med Ann Meet Abstr 2009;50:186.

    Google Scholar 

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Author information

Affiliations

  1. Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada

    Michel Lalonde MSc

  2. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    David Birnie MD, Terrence D. Ruddy MD, FRCPC, FACC & Robert A. deKemp PhD

  3. Division of Nuclear Medicine, The Ottawa Hospital, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada

    Terrence D. Ruddy MD, FRCPC, FACC & Richard W. Wassenaar PhD

Authors
  1. Michel Lalonde MSc
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  2. David Birnie MD
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  3. Terrence D. Ruddy MD, FRCPC, FACC
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  4. Robert A. deKemp PhD
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  5. Richard W. Wassenaar PhD
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Corresponding author

Correspondence to Richard W. Wassenaar PhD.

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Lalonde, M., Birnie, D., Ruddy, T.D. et al. SPECT blood pool phase analysis can accurately and reproducibly quantify mechanical dyssynchrony. J. Nucl. Cardiol. 17, 803–810 (2010). https://doi.org/10.1007/s12350-010-9231-5

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  • DOI: https://doi.org/10.1007/s12350-010-9231-5

Keywords

  • Heart failure
  • gated blood pool imaging
  • left ventricular function
  • SPECT
  • image processing